1例挤压综合征术后感染患者的药学监护.pdfVIP

中国药物应用与监测2011年8月第8卷第4期 Chinese Journal of Drug Application and Monitoring, Vol.8, No.4, August 2011 1例挤压综合征术后感染患者的药学监护 史文慧，郭　蓉，罗朝利（北京军区北戴河疗养院药剂科，河北 秦皇岛 066100 ） [摘要] 1例26 岁男性患者，因一氧化碳中毒后导致双下肢挤压伤入院。入院后行挤压综合征减张术后发生感染，肌肉持续 坏死、筋膜感染，曾使用多种抗菌药物，感染控制不佳，多次分泌物培养为志贺氏菌属。临床药师会诊后，制订了个体化给 药方案，第一疗程10 d ：亚胺培南西司他丁联合克林霉素；第二疗程14 d ：克林霉素联合哌拉西林他唑巴坦；第三疗程5 d ： 头孢呋辛。3 d 后，体温正常，白细胞和粒细胞降低，2 1 d 后无肌肉持续坏死现象，23 d 后，体温、血常规均正常，感染得到控 制。 [关键词] 挤压综合征；志贺氏菌；药学监护；感染 [ 中图分类号] R978.1 [文献标识码] A [文章编号] 1672 – 8157(2011)04 – 0221 – 03 Pharmaceutical care on one patient with postoperative infection after crush syndrome SHI Wen-hui, GUO Rong, LUO Chao-li ( Beidaihe Sanatorium of Beijing Military Area, Qinhuangdao 066100, China ) [ABSTRACT] One 26-year-old male patient with crush injuries to both lower extremities after being involved in carbon monoxide poisoning was admitted to hospital. After the operation for treatment of crush syndrome, he developed postoperative infection, sustained muscle necrosis and fascial infections. The patient used some antimicrobial agents, while the efficacy of infection control was poor, and Shigella was found from secretions. After consultation with clinical pharmacists, the individualized dosing regimen was made. In the first treatment course (10 days), imipenem-cilastatin and clindamycin were combined. During the second course(14 days ), clindamycin and piperacillin-tazobactam were given in combination. In the third course, cefuroxime was given for 5 days. Three days later, the body temperature was normal, the number of white blood cells and granulocytes decreased, 2 1 days later no continuing muscle necrosis occurred, 23 days later the body temperature and blood routine were normal, infection was controlled. [KEY WORDS] Crush syndrome; Shigella; Pharmaceutical care; Infection 挤压综合征(crush syndrome ，CS) 是指在人体肌 切开减张术治疗，是传统的治疗CS 的有效手段之一。 肉丰