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目的:探讨临床药师参与临床抗感染治疗用药过程的模式。方法:对1例重型颅脑损伤双侧去骨瓣减压术后肺部和颅内感染患者的抗细菌和抗真菌治疗提出合理化用药建议,并进行用药监护。结果:临床药师先后建议采用氟康唑治疗方案和两性霉素B治疗方案分别治疗32 d和28 d,治疗期间分别针对分流管相关表皮葡萄球菌和施氏假单胞菌感染提出治疗建议对伏立康唑和两性霉素B不良反应预警和监护,针对药敏结果变化及时调整抗感染治疗,治疗效果明显。结论:临床药师参与药物治疗过程可优化治疗方案,有利于医药团队协作。
Objective: To explore the clinical pharmacist participation in the clinical anti-infective treatment medication model. Methods: To rationalize the antibacterial and antifungal treatment of patients with pulmonary and intracranial infection after decompressive craniectomy in one patient with severe craniocerebral injury, and to take medication supervision. Results: The clinical pharmacist proposed the treatment of fluconazole and amphotericin B for 32 d and 28 d, respectively. During the treatment period, they proposed the treatment of shunt-associated Staphylococcus epidermidis and Pseudomonas stutzeri respectively. And amphotericin B adverse reaction early warning and custody, timely adjustment of anti-infective treatment for changes in susceptibility results, the treatment effect is obvious. Conclusion: The participation of clinical pharmacists in the drug treatment process can optimize the treatment plan, which is beneficial to the medical teamwork.