【摘要】 目的:通过对老年重症医院获得性肺炎患者治疗方案的优化干预和药学监护,探讨临床药师在合理用药中的作用。方法:对1例老年重症医院获得性肺炎患者治疗进行全程药学监护,结合临床诊疗指南和文献报道,对抗感染药、糖皮质激素、抗凝药等重点药物的个体化应用进行分析和评价,并针对药物治疗方案提出干预措施和药物警戒。结果:通过临床药师提供个体化药学服务,及时发现和解决了重症患者药物治疗中存在的问题。结论:临床药师参与重症患者治疗方案的设计和干预,有利于促进合理用药。更多还原

【Abstract】 OBJECTIVE: To optimize the therapeutic regimen and provide pharmaceutical care for an elderly patient with severe hospital-acquired pneumonia and explore the role of clinical pharmacists in rational use of drug.METHODS: Pharmaceutical care was provided by clinical pharmacist for an elderly patient with severe hospitalacquired pneumonia,and the individualized use of crucial drugs such as anti-infective agents,glucocorticoids and anticoagulant drugs were analyzed with clinical diagnosis & treatment gulideline as reference; meanwhile,aimed at the therapeutic regimens,intervention measures and pharmacovigilance were put forward. RESULTS: Through individual pharmaceutical care provided by clinical pharmacists,many problems involved in the treatment have been detected and solved. CONCLUSIONS: The participation of clinical pharmacists in the design and intervention on the therapeutic regimens is conducive to the promotion of rational use of drug.更多还原