今日药学

2021, v.31(03) 200-203

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外科临床药师参与1例肝肾联合移植术后个体化治疗的药学实践
Pharmaceutical Practice of Clinical Pharmacist in A Patient after Liver and Renal Transplantation

梁丹;何清;伍俊妍;
LIANG Dan;HE Qing;WU Junyan;Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University;

摘要(Abstract):

目的以1例高草酸尿症肝肾联合移植术后患者为例,探讨临床药师对患者的个体化药学服务。方法外科临床药师参与1例肝肾移植术后患者在ICU治疗期间的药学监护,关注患者病情变化,参与调整优化给药方案;通过血药浓度和基因检测,运用循证药学提出药学建议、关注药品不良反应和相互作用等。结果通过对患者抗感染治疗方案的调整及优化,感染得到有效控制;免疫抑制剂可维持在有效治疗窗范围,避免严重药品不良反应的发生。结论外科临床药师深入临床实践,紧密配合临床,发现问题并及时提出解决问题的方法,促进临床用药的安全、合理和有效。
OBJECTIVE To explore the role of clinical pharmacist in the individualized treatment,through a case of liver and renal transplantation patient after hyperoxaluria. METHODS Surgical clinical pharmacist took part in the ICU treatment of liver and renal transplant recipient and provided the full range of clinical pharmacy service by adjusting and optimizing the medication regimen according to the patient's condition.Through blood concentration,surgical clinical pharmacist used evidence-based pharmacy to make the individualized drug administration,paying attention to drug interaction and adverse reactions. RESULTS The infection was effectively controlled by adjusting and optimizing the treatment plan.The blood concentrations of immunosuppressive agent were maintained within the effective treatment window which avoided the serious adverse reactions. CONCLUSION It is good for surgical clinical pharmacist to go into clinical practice,find clinical problems and solve problems in time which can promote the safety and effectiveness of the drug treatment.

关键词(KeyWords): 外科临床药师;肝肾联合移植术;药学监护
surgical clinical pharmacist;liver and renal transplantation;pharmaceutical care

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作者(Author): 梁丹;何清;伍俊妍;
LIANG Dan;HE Qing;WU Junyan;Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University;

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