临床药师参与会诊颅内感染患者遴选抗菌药物的体会

李晓兰

[摘要] 目的 探讨临床药师参与会诊颅内感染患者遴选抗菌药物的效果。 方法 本院于2015年9月29日收治1例疑似颅内感染患者，经临床药师参与会诊和遴选抗菌药，入院后治疗药物由头孢哌酮舒巴坦调整为替加环素。抗感染治疗5 d后，综合评估患者状况，临床药师建议停用替加环素，继续给予头孢唑肟降阶梯治疗。 结果 经有效的抗菌治疗后，患者血常规、红细胞沉降率、降钙素原（PCT）、C反应蛋白（CRP）炎性指标较前好转，咳嗽、咳痰等临床症状明显减轻。 结论 临床药师通过参与临床药物治疗，能够全面了解药物治疗面临的问题，提出合理的用药方案，这对提高药师专业水平、促进临床用药合理安全具有重要作用。

[关键词] 临床药师；会诊；颅内感染；药物治疗；体会

[中图分类号] R978.1 [文献标识码] A [文章编号] 1674-4721（2016）03（c）-0103-04

[Abstract] Objective To explore the effect of clinical pharmacist participating in the selection of antimicrobial agents for consultation in patients with intracranial infection. Methods 1 patient with suspected intracranial infection in September 29，2015 was admitted in our hospital.After consultation with the help of clinical pharmacist and selection of antimicrobials，the treatment drug was adjusted from cefoperazone and sulbactam to tigecycline.After treatment for 5 days，the situation of patient was evaluated comprehensive.The clinical pharmacist advised to stop using tigecycline and cefazolin oxime was continuing used for down stairs treatment. Results After effective antimicrobial treatment，the inflammatory indicators liked hemogram，blood sedimentation，procalcitonin （PCT） and C-reactive protein were better than that before treatment and the clinical symptoms liked cough and expectoration were obvious alleviated. Conclusion Clinical pharmacist participating in clinical drug treatment can comprehensive understand the problem that drug treatment is facing and give reasonable treatment project，which have important role in enhancing pharmacist professional level，promoting the safety and reasonable drug use in clinical.

[Key words] Clinical pharmacist；Consultation；Intracranial infection；Drug treatment；Experience

颅内感染常发生在颅脑手术或脑外伤后，是中枢神经系统感染性疾病，而中枢神经系统是人体重要的生命中枢。正常情况下，脑组织处于头皮、颅骨和脑膜的包围保护，来源于外界感染的发生率较其他组织少。另外，血-脑脊液屏障的存在又可使脑组织免于遭受血源播散病原体的侵袭。当外围组织或血-脑脊液屏障遭到破坏时，脑组织对细菌入侵又较其他组织易感。颅内感染主要由细菌、病毒、真菌和寄生虫引起[1]，病程一般较长，大多起病急，病情常危重，进展迅速，多于起病后1～2 d因症状明显而就诊。有效抗菌药物难以在脑脊液中达到足够浓度，故导致耐药率居高不下。……