1例软骨肉瘤患者半盆截肢术后感染的药学监护.pdfVIP

中国药物应用与监测2012年2月第9卷第1期 Chinese Journal of Drug Application and Monitoring, Vol.9, No.1, February 2012 1 例软骨肉瘤患者半盆截肢术后感染的药学监护 张 威，杨 媛，卞 婧，甄健存（北京积水潭医院药剂科，北京 100035 ） [摘要] 1例59 岁女性患者，因软骨肉瘤术后复发行半盆截肢，术后伤口感染，行清创、灌洗、抗生素治疗。手术预防用药为 头孢曲松，不宜同时合用含钙液体。术后一周患者出现伤口渗液、发热等症状，术中培养为鲍曼不动杆菌+ 粪肠球菌，术后 进行灌洗，灌洗结束后开始抗感染治疗，依替米星联合氨苄西林/ 舒巴坦静脉滴注。由于患者术后插尿管时间较长，出现短 时低热症状，尿培养为克柔念珠菌，其他临床情况尚可，考虑为污染菌珠，未予特殊处理。患者感染控制，出院，药师嘱其氯 膦酸二钠胶囊早晨空腹白水送服，禁与牛奶同服，服后活动。 [关键词] 软骨肉瘤；术后感染；药学监护；临床药师 [ 中图分类号] R978.1 [文献标识码] A [文章编号] 1672 – 8157(2012)01 – 0031 – 03 Pharmaceutical care on a patient with the right pelvic amputation after postoperative recurrent infection of chondrosarcoma ZHANG Wei, YANG Yuan, BIAN Jing, ZHEN Jian-cun(Department of Clinical Pharmacy, Beijing Jishuitan Hospital, Beijing 100035, China) [ABSTRACT] One 59-year-old woman with recurrent chondrosarcoma was hospitalized for the right pelvic amputation . The patient received treatment of debridement, lavage, antibiotic for wound infection after operation. Prophylactic antibiotic was ceftriaxone during the surgery. Clinical pharmacists suggested that ceftriaxone can not be combined with solution of calcium. The patient got a fever and the wound began to exudate in a week after operation. According to intraoperative culture, enterococcus faecalis and acinetobacter baumannii were found, and intravenous infusion of etimicin combined with ampicillin/sulbactam were used for anti-infective therapy after lavage. Although the patient developed fever temporarily and krusei of the urine was shown after relatively long time catheter inserted, clinical pharmacists suggested not to give added antibiotic therapy temporarily as the stable clinical condition was not conformed. Clinical pharmacist instructed the patient that clodronate capsules should be swallowed by the water in the morning before breakfast and not take with milk, besides that appropriate activities aft