临床药师参与1例新型隐球菌性脑膜炎抗真菌治疗的病例分析_孙闻续.pdfVIP

临床药师参与1例新型隐球菌性脑膜炎抗真菌治疗的病例分析 ＊ # 孙闻续 ，徐 珽（四川大学华西医院临床药学部，成都 610041） 中图分类号 R519.4 文献标志码 A 文章编号 1001-0408（2015）20-2854-04 DOI 10.6039/j.issn. 1001-0408.2015.20.41 摘 要 目的：探讨临床药师在新型隐球菌性脑膜炎患者抗真菌治疗中的药学服务方法。方法：临床药师参与1例新型隐球菌性 脑膜炎患者的药物治疗过程，从协助医师优化抗真菌药物治疗方案、对患者进行药学监护、不良反应处理及用药教育等方面提供 药学服务。使用两性霉素B 期间，患者出现顽固性低钾血症，临床药师建议医师降低两性霉素B 剂量，加用伏立康唑抗真菌治 疗。结果：调整抗真菌治疗方案后，患者未再出现低血钾；经系统抗真菌治疗11周后，患者病情较前明显好转。结论：临床药师参 与新型隐球菌性脑膜炎抗真菌治疗的心得是：遵循指南，但不失灵活处理；主动服务，细节保障用药安全。 关键词 临床药师；新型隐球菌性脑膜炎；抗真菌药；药学监护 Case Analysis of the Participation of Clinical Pharmacist in Antifungal Drug Treatment of New Type Crypto- coccal Meningitis SUN Wen-xu ，XU Ting（Dept. of Pharmacy ，West China Hospital ，Sichuan University ，Chengdu 610041，China ） ABSTRACT OBJECTIVE ：To explore the method of pharmaceutical care for antifungal drug treatment of new type crypto- coccal meningitis by clinical pharmacist. METHODS ：Clinical pharmacist participated in the drug treatment process for a pa- tient with new type cryptococcal meningitis. Clinical pharmacist provided pharmaceutical care in following aspects ：assisting doctor to optimize antifungal drugs treatment plan ，providing patients pharmaceutical monitoring and medication education ， etc. During amphotericin B treatment ，the patient developed refractory hypokalemia. Clinical pharmacists suggested doctors to reduce the dose of amphotericin B and additionally use voriconazole for antifungal treatment. RESULTS ：The patient devel- oped refractory hypokalemia no more after the plan was adjusted. After 11 weeks of systematic antifungal treatment ，the pa- tient was on the mend. CONCLUSIONS ：The participation of clinical pharmacist in antifungal treatment of new type cryptococ- cal meningitis indicates that following the instructions ，but not lost flexible disposal ；providing service actively ，and details i