| 1例鹦鹉热衣原体重症肺炎并发药物性肝损伤患者的治疗及药学监护 |
| 投稿时间：2021-03-19 修订日期：2021-06-16 点此下载全文 |
| 引用本文：胡云英,冯瑾,贾耀,葛继芸,鲍蕾蕾,黄玉凤.1例鹦鹉热衣原体重症肺炎并发药物性肝损伤患者的治疗及药学监护[J].药学实践杂志,2021,39(6):552~556 |
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| 中文摘要:目的 通过参与鹦鹉热衣原体感染致重症肺炎并发药物性肝损伤老年患者的药学监护，探讨临床药师在合理用药中的作用。方法 临床药师参与1例鹦鹉热衣原体重症肺炎并发药物性肝损伤患者的治疗，根据基因二代测序结果，通过查阅资料了解病原菌特点，结合患者肝肾功能及临床治疗效果与医师共同制订和调整用药方案，在分析疾病、调整用药、不良反应等方面实施个体化药学监护，并进行患者教育。结果 初始经验性给予替考拉宁联合亚胺培南-西司他丁钠抗感染治疗效果不佳，确诊鹦鹉热衣原体及白念珠菌感染后，予多西环素联合阿奇霉素及氟康唑抗感染治疗，药学监护中发现药物性肝损伤的不良反应，临床药师协助医师调整方案为多西环素联合克拉霉素，并进行异甘草酸镁联合多烯磷脂酰胆碱保肝对症处理后，患者感染和肝功能明显好转，预后良好。结论 临床药师运用专业知识为患者提供个体化的药学服务，有助于提高临床用药的合理性、安全性及有效性。 |
| 中文关键词:鹦鹉热衣原体 重症肺炎 抗菌药物 药物性肝损伤 药学监护 |
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| Treatment and pharmaceutical care of one patient with Chlamydia psittaci pneumonia complicated by drug-induced liver injury |
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| Abstract:Objective To explore the role of clinical pharmacists in rational drug use through the pharmacy care of an elderly pneumonia patient with Chlamydia psittaci infection and drug-induced liver injury. Methods The clinical pharmacists participated in the treatment of one patient with Chlamydia psittaci pneumonia and drug-induced liver injury. Based on the results of second-generation gene sequencing, the characteristics of the pathogen were learned by literature search. The clinical pharmacists monitored the patient’s liver and kidney function, provided a new medication treatment plan to Doctors, and performed patient education during the treatment. Results The initial empirical anti-infective treatment with teicoplanin and imipenem-cilastatin was not effective. After the diagnosis of Chlamydia psittaci and Candida albicans infection, the combination of doxycycline with azithromycin and fluconazole was administered. Drug-induced liver injury was found with this treatment. The clinical pharmacist proposed to switch to doxycycline and clarithromycin with co-administration of magnesium isoglycyrrhizinate and polyene phosphatidylcholine to protect the liver. With this new regime, patient's liver function was improved and the infection was under control. Conclusion Individualized pharmaceutical cares provided by clinical pharmacists helped the safe, rational and effective use of medications. |
| keywords:Chlamydia psittaci severe pneumonia antimicrobial agents drug-induced liver injury pharmaceutical care |
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