对1例肝硬化并发多种疾病患者的个体化药学监护

摘要

One male patient with liver cirrhosis caused by hepatitis B complicated with other diseases was hospitalized for peritonitis. After got better by diuretic and anti-infection treatments, the patient appeared secondary diseases such as hepatic encephalopathy, gastrointestinal hemorrhage and upper respairatory tract infection. Clinical pharmacists participated in pharmaceutical care in the whole therapeutic process. Clinical pharmacists optimized the regimen of antibacterials for the treatment of liver ascites by using cefodizime instead of levofloxacin which caused more burden, increased the dosage of ornithine-aspartate for curing hepatic encephalopathy, identified one drug fever caused by two hemostatic drugs aminomethylbenzoic acid and etamsylate, and suggested using imipenem-cilastatin to treat left lower pneumonia caused by upper respiratory infections. All of the suggestions were adopted by the doctors. This pharmaceutical care achieved effectively.%1例肝硬化并发多种疾病的男性患者，因腹膜炎入院。给予利尿、抗感染治疗好转后，相继出现肝性脑病、消化道出血、上呼吸道感染。药师全程参与药学监护，对治疗肝腹水的抗生素用药方案予以优化，弃用加重肾负担的左氧氟沙星，单用头孢地嗪；对肝性脑病行降血氨药剂量调整，增加门冬氨酸鸟氨酸用量；鉴别发热为止血药（氨甲苯酸+酚磺乙胺）引起的药物热；建议对上感引发的左下肺炎采用高级别抗菌药亚胺培南西司他丁等，所提建议均被医生采纳，并取得良好效果。