肝硬化失代偿期合并艰难梭菌脾脓肿患者的药学监护及文献分析 点击下载
| 论文标题： | 肝硬化失代偿期合并艰难梭菌脾脓肿患者的药学监护及文献分析 |
| 英文标题： | |
| 中文摘要： | 目的 为肝硬化失代偿期合并艰难梭菌脾脓肿患者的药学监护提供参考。方法临床药师参与1例上述复杂病症患者的药学监护过程；检索中国知网、万方数据、维普网、PubMed、Embase、WebofScience，收集艰难梭菌脾脓肿的相关文献并进行分析。结果临床药师根据宏基因组二代测序结果、影像学特征，结合药物组织穿透性，建议将头孢曲松联合甲硝唑调整为静脉万古霉素联合甲硝唑；针对出现的低钾血症，建议停用呋塞米片并加用枸橼酸钾颗粒；针对患者要求出院，临床药师为患者制定了出院后的用药教育方案。医生采纳了临床药师的建议；患者经治疗后好转，未出现肾损伤。文献分析结果显示，共纳入11例患者，其中男性9例，女性2例，年龄为32～90岁；8例患者有艰难梭菌感染史；抗感染方案以万古霉素和甲硝唑为主，经治疗后3例患者死亡。结论临床药师通过明确病原学、优化抗感染给药方案、监测药物不良反应、制定出院用药教育方案等药学服务手段，保障患者用药安全。 |
| 英文摘要： | OBJECTIVE To provide a reference for pharmaceutical care in patients with decompensated cirrhosis complicated with Clostridioides difficile splenic abscess. METHODS Clinical pharmacists participated in the whole-process pharmaceutical care of one patient with the above complex conditions. Retrieved from CNKI， Wanfang Data， VIP， PubMed， Embase and Web of Science databases，relevant literature about C. difficile splenic abscess was collected and analyzed. RESULTS Based on the results of metagenomic next-generation sequencing，imaging characteristics， and tissue penetration of antimicrobial agents， the clinical pharmacist suggested switching from ceftriaxone combined with metronidazole to intravenous vancomycin combined with metronidazole. For the hypokalemia that developed in the patient， the clinical pharmacist suggested discontinuing Furosemide tablets and adding Potassium citrate granules. When the p atient requested hospital discharge， the clinical pharmacist developed a post-discharge medication education plan. The physician adopted the clinical pharmacist’s recommendations. The patient improved after treatment without renal injury. Results of the literature analysis showed that among 11 involved patients，there were 9 males and 2 females，aged 32 to 90 years old，8 patients had a history of C. difficile infection. Vancomycin and metronidazole constituted the primary anti-infective regimens， and 3 patients died after treatment. CONCLUSIONS The clinical pharmacists ensured patients’ medication safety through pharmaceutical interventions including identifying the pathogen， optimizing anti-infective regimens， monitoring adverse drug reactions， and formulating a discharge medication education plan. |
| 期刊： | 2026年第37卷第14期 |
| 作者： | 魏秋芳；潘新波；缪苗苗 |
| 英文作者： | WEI Qiufang，PAN Xinbo，MIAO Miaomiao |
| 关键字： | 脾脓肿; 肝硬化; 失代偿期; 艰难梭菌; 宏基因组二代测序; 药学监护 |
| KEYWORDS： | splenic abscess; liver cirrhosis; decompensation; Clostridioides difficile; mNGS; pharmaceutical care |
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