对1例脑出血患者的药学监护.pdfVIP

中国药物应用与监测 2010年4月第7卷第2期 Chinese Journal of Drug Application and Monitoring, Vol.7, No.2, April 2010 对1 例脑出血患者的药学监护 1 2 3 1 （1. 山东大学齐鲁医院药剂科，山东 济南 250012 ；2. 山东大学齐鲁医院急诊外科，山东 济南 欧 扬 ，王兆云 ，夏 文 ，周 文 250012 ；3. 山东大学齐鲁医院神经内科，山东 济南 250012 ） [摘要] 1例61 a 男性患者，因“丘脑出血合并高血压、2 型糖尿病”入院，给予脱水、利尿、脑保护、促脑代谢、降血压、降血 糖等治疗。入院后第11天患者发生吸入性肺炎，医生经验性给予哌拉西林/ 他唑巴坦抗感染治疗。结合患者肾功能低下、哌 拉西林/ 他唑巴坦与依达拉奉联合应用可能出现肾衰竭加重情况，临床药师建议将抗菌药物改为头孢哌酮/ 舒巴坦；同时对 硝苯地平合用二甲双胍出现低血糖症状进行分析，并建议两药间隔2 h 以上服用；并对糖尿病合并高血压患者降压药物选择 进行讨论，建议将硝苯地平改为培哚普利。经合理优化治疗方案后，患者避免了肾损伤加重，血压及血糖控制平稳，病情明 显好转。 [关键词] 临床药师；药学监护；丘脑出血 + [ 中图分类号] R969.3 ；R972 .4 [ 文献标识码] A [ 文章编号] 1672 – 8157(2010)02 – 0113 – 03 Pharmaceutical care on a patient with thalamic hemorrhage 1 2 3 1 OU Yang , WANG Zhao-yun , XIA Wen , ZHOU Wen (1. Department of Pharmacy, Qilu Hospital of Shandong University, Jinan 250012, China; 2. Department of Emergency Surgery, Qilu Hospital of Shandong University, Jinan 250012, China; 3. Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, China) [ABSTRACT] A 61-year-old male patient with thalamic hemorrhage, hypertension and type 2 diabetes mellitus was hospitalized. The patient was treated with dehydration, diuresis, cerebral protection, promoting brain metabolism, controlling blood pressure and lowering blood sugar. Eleven days after his hospitalization, the patient developed aspiration pneumonia, and he was given empirical anti-infection treatment with piperacillin/tazobactam. As the interaction between edaravone and piperacillin/tazobactam may exacerbate renal failure, considering the renal insufficiency of the patient, clinical pharmacist proposed to replace antimicrobial 3 讨论 [参考文献] 患者入院检查时发现肝脏多发转移灶，并伴有 [1] Van Cutsem E, Nordlinger