【摘要】 目的为围产期患者的万古霉素剂量调整提供参考。方法对收治的1例临床药师参与的围产期万古霉素血药浓度异常波动和调整的患者资料进行回顾性分析,临床药师结合临床药学专业知识,从患者特殊的病理生理状态改变、万古霉素血药浓度影响因素、药代动力学等方面进行分析,提供剂量调整的建议,并实施全程药学监护。结果与结论在该病例治疗期间,医师经验性选用万古霉素抗感染治疗,根据血药浓度进行剂量调整,但血药浓度未能达标,出现异常波动。临床药师的分析提示该患者特殊的病理生理状态改变是最主要的影响原因,进而对患者进行剂量调整和药学监护,以协助临床避免不良事件的发生,保障安全、合理的用药。更多还原

【Abstract】 Objective To investigate the experience for adjusting the dose of vancomycin in perinatal women. Methods A case of perinatal woman with abnormal fluctuation blood concentration of vancomycin, which clinical pharmacist participated in her dose adjustment was analyzed retrospectively. Combined with professional knowledge of clinical pharmacy, the patient’s special pathophysiological condition, factors affecting plasma concentration and pharmacokinetics of vancomycin, clinical pharmacist analyzed the mechanics, provided suggestions for dose adjustment and the whole process of pharmaceutical care was implemented. Results and conclusion During the treatment of this patient, doctors empirically chosen vancomycin as anti-infective treatment. The dosage was adjusted according to the blood concentration of vancomycin, but it failed to meet the standard, resulting in abnormal fluctuation of blood concentration. Clinical pharmacists found out that that the special pathophysiological changes might be the primary cause. Then dose adjustment and pharmaceutical care were carried out following, to avoid adverse events and ensure safe and rational use of the drugs.更多还原