1例万古霉素致急性肾损伤老年患者行血浆置换术的用药分析和药学监护 点击下载
论文标题： 1例万古霉素致急性肾损伤老年患者行血浆置换术的用药分析和药学监护
英文标题：
中文摘要： 目的：为发生万古霉素致急性肾损伤（AKI）的患者的药学监护提供参考。方法：对我院2017年9月收治的1例万古霉素致AKI后通过血浆置换术救治的老年患者的临床资料进行回顾性分析，结合临床药学专业知识，从患者抗感染治疗方案、AKI发生高危因素及救治措施等方面进行分析，并在出现药物不良反应后复习相关文献，总结经验教训，提出老年患者使用万古霉素后出现AKI后的解决措施，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并发生AKI；临床药师分析患者为老年女性，具备高危因素（肾功能生理性减弱、超过万古霉素推荐使用剂量、用药时间过长）且已发生AKI，建议立即停用万古霉素并行血浆置换术（置换时间1.5 h，置换血浆1 300 mL）救治，第2日查万古霉素血药谷浓度快速下降（31.3→19.7 μg/mL），患者肾功能开始恢复（血肌酐：160.6→136.5 μmol/L；肌酐清除率：19.49→22.94 mL/min；肾小球滤过率：29.00→35.30 mL/min），AKI减轻。通过对本案例的分析，建议临床对万古霉素在老年患者中的使用应更加谨慎，应认真评估危险因素、权衡利弊、评估肾功能、个体化调整药物剂量。临床药师应加强对使用万古霉素患者的药学监护，协助临床避免不良事件的发生，保障用药安全、合理。
英文摘要： OBJECTIVE： To provide reference for pharmaceutical care of vancomycin-induced acute kidney injury （AKI） patients. METHODS： Clinical data of a AKI elderly patient admitted to our hospital in Sept. 2017 were analyzed retrospectively. Combined with professional knowledge of clinical pharmacy， anti-infective plan， AKI high-risk factor and treatment measures were analyzed. After the occurrence of ADR， relevant literatures were reviewed； the experience and lessons were summarized； the solutions were proposed， and the whole process of pharmaceutical care was implemented after elderly patient suffered from AKI due to the use of vancomycin. RESULTS & CONCLUSIONS： Pharmacists selected vancomycin anti-infective treatment empirically for the patient during treatment. The patient suffered from AKI. The clinical pharmacist analyzed that the patient was an elderly female with high risk factors （physiological impairment of renal function， exceeding recommended dose of vancomycin； overlong medication duration） and then occurrence of AKI. It was suggested to disable vancomycin immediately and use plasma replacement for treatment （replacing 1 300 mL plasma for 1.5 h）. The trough concentration of vancomycin declined rapidly on the second day （31.3→19.7 μg/mL）， and the renal function of the patient began to recover （Scr： 160.6→136.5 μmol/L； Ccr： 19.49→22.94 mL/min； GFR： 29.00→35.30 mL/min） so as to relieve AKI effectively. So， it is suggested that clinical use of vancomycin in elderly patients should be more cautious， risk factors， advantages， disadvantages and renal function also should be evaluated； drug dosage should be individually adjusted. Clinical pharmacists should strengthen the pharmaceutical care of patients using vancomycin to help avoid adverse events and ensure the safety and rationality of drug use.
期刊： 2018年第29卷第19期
作者： 李薇，尹娜，江灏，刘耀，唐敏
英文作者： LI Wei，YIN Na，JIANG Hao，LIU Yao，TANG Min
关键字： 万古霉素；血浆置换；急性肾损伤；老年患者
KEYWORDS： Vancomycin； Plasma exchange； Acute kidney injury； Elderly patient
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