摘要
1例75a女性患者,因左足肿胀、皮肤破溃2月余,发热4d入院,入院后接受降糖、营养神经、改善微循环、抗感染、降压、调脂等综合治疗方案。药师参与了患者住院期间抗菌药物治疗方案的制定,药物不良事件的监护与处理等过程,为其提供了全程的药学服务。患者初始抗感染治疗时经验性选择头孢米诺联用莫西沙星,药敏结果回示后改为万古霉素静脉滴注,初次输液开始约20min后,患者出现面颈部发红、伴瘙痒,考虑为药物引起的红人综合征,次日滴速适当控制后未再出现类似症状。用药16d后,足部分泌物菌培养结果为阴性,遂停用万古霉素。患者用药期间,肌酐清除率由58mL·min-1下降至51mL·min-1,提示在应用万古霉素期间应密切监测其肾毒性等不良反应。患者于入院第5天清晨空腹血糖为2.9mmol·L-1,言语少,精神萎靡,但无饥饿、心慌、出汗等低血糖症状,当即嘱患者食糖块,卧床休息,20min后复查血糖升至5.8mmol·L-1,患者精神恢复,提示老年病人在应用胰岛素期间应密切监测血糖,以防发生症状不典型的低血糖事件。
A 75-year-old female patient was admitted to hospital for swelling and ulcer of the left foot for over 2 months,and having a fever for 4 days.After admission,she received an integrated therapy including blood glucose control,neural protection,circulation improvement,anti-infection,blood pressure control,blood-lipid adjustment,etc.Clinical pharmacist participated in the process of programming anti-infection protocol and monitoring the adverse drug events,providing comprehensive pharmaceutical care.For the anti-infection therapy,the patient received cefminox sodium and moxifloxacin empirically.The protocol was changed to vancomycin on the basis of the bacteria culture result.On the first day when the patient was administered with vancomycin intravenously,her face and neck turned red and felt pruritus 20 minutes after the infusion,which was considered red man syndrome,and was resolved by controlling the dropping speed.The bacteria culture result showed negative after vancomycin using for 16 days.The patient＇s creatinine clearance decreased from 58 mL·min-1 to 51 mL·min-1,which showed that the nephrotoxicity of vancomycin should be paid close attention to.The patient＇s fasting blood glucose was 2.9 mmol·L-1 on the fifth day after admission,while she did not show typical hypoglycemic symptoms but a low spirit.After chewing some sugars and having a rest,her blood glucose raised to 5.8 mmol·L-1 and her spirit had restored,which suggested that the blood glucose should be monitored closely when insulin was used especially for elder patients for fear that atypical hypoglycemia occurred.
出处
《中国药物应用与监测》
CAS
2010年第3期177-179,共3页
Chinese Journal of Drug Application and Monitoring
基金
2010年度山东省药学会临床药学奥赛康中青年科研资助项目
关键词
糖尿病足
老年
感染
药学监护
Diabetic foot
Elderly
Infection
Pharmaceutical care
