临床药师参与处理1例哌拉西林钠他唑巴坦钠引起的血小板减少症患者的分析

解沛涛+汪震

摘 要 1例63岁的脑外伤患者在接受硬膜外血肿治疗13 d后发生了导管相关性泌尿系统感染，医师先后给予左氧氟沙星和哌拉西林钠他唑巴坦钠治疗，但在加用哌拉西林钠他唑巴坦钠治疗3 d后，患者的血小板计数从127×109/L降至44×109/L。临床药师早期识别了患者血小板减少发生的原因，及时建议改用阿米卡星治疗并为医师采纳。10 d后患者的泌尿系统感染痊愈，且其间未再出现药物不良反应。

关键词 哌拉西林钠他唑巴坦钠 血小板减少症 泌尿系统感染 阿米卡星 临床药师

中图分类号：R558.2； R978.11 文献标识码：C 文章编号：1006-1533（2017）15-0071-04

Analysis of a case of the treatment of piperacillin sodium and tazobactam sodiuminduced thrombocytopenia involved by clinical pharmacists

XIE Peitao1*， WANG Zhen2（1. Department of Pharmacy， Erdos Central Hospital， Inner Mongolia 017000， China； 2. Department of Pharmacy， Tongji Hospital

of Tongji Medical College， Huazhong University of Science and Technology， Hubei 430000， China）

ABSTRACT The catheter associated urinary tract infection occurred in a 63 years old patient with traumatic brain injury after his epidural hematoma was treated for 13 days. Physician had given him levofloxacin plus piperacillin sodium and tazobactam sodium one after another， however， his platelet count was significantly reduced from 127×109/L to 44×109/L after he was treated with piperacillin sodium and tazobactam sodium for 3 days. Clinical pharmacists identified the causes of thrombocytopenia and timely suggested to switch to amikacin. The urinary tract infection in this patient was cured after physician accepted this suggestion and amikacin treatment was lasted for 10 days， and furthermore this kind of adverse drug reactions no longer occurred during this period.

KEY WORDS piperacillin sodium and tazobactam sodium； thrombocytopenia； urinary tract infection； amikacin； clinical pharmacist

藥源性血小板减少症是指因某些药物引起血小板计数下降（<100×109/L）而导致的出血性疾病，在感染性疾病患者治疗中常被忽视[1]。本文介绍1例导管相关性泌尿系统感染患者在治疗期间出现血小板计数下降，临床药师早期识别其血小板计数下降的原因，并结合患者情况建议调整治疗方案的临床实践，以探讨临床药师在临床治疗团队中的作用。

1 病例资料

一患者，男，63岁，因“头部外伤后8 h伴头痛”入住鄂尔多斯市中心医院。该患者此前于当地医院急诊就医，头颅CT检查显示其右侧颞部硬膜外血肿、左侧颞顶部硬膜下血肿、蛛网膜下腔出血、左颞叶脑挫伤，当地医院对症处理后转入鄂尔多斯市中心医院进一步治疗。患者伤后一直精神差，曾呕吐数次，但无肢体抽搐现象。既往体健，家属诉患者2个月前因上呼吸道感染自行口服阿莫西林克拉维酸钾（具体剂量不详）治疗1周，无其他用药史。……