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目的:临床药师通过参与肾功能不全伴胆总管结石的老年女性患者临床治疗的药学监护,探讨临床药师以药物治疗为目的的临床药学思维。方法:临床药师对1例老年胆总管结石伴肝肾功能不全患者的临床分析,评估了其肠外营养支持、抗菌药物调整、保肝药物选择的药学监护过程。结果:临床药师通过参与其抗感染、肠外营养药物治疗方案的优化,和临床全程药学监护,确保了临床合理用药,提高了临床疗效。结论:临床药师发挥了专业知识,评估患者的营养状况制订了肠外营养和抗菌药物的选用,确保了临床疗效。
OBJECTIVE: To investigate the clinical pharmacology of clinical pharmacists for the purpose of drug therapy through the clinical monitoring of the clinical treatment of elderly female patients with renal dysfunction and choledocholithiasis. Methods: Clinical pharmacists analyzed the clinical analysis of one case of senile choledocholithiasis with liver and renal insufficiency, and evaluated the parenteral nutrition support, the adjustment of antibacterial drugs and the choice of hepatoprotective drugs. Results: By participating in the anti-infective and parenteral nutrition therapy regimens, clinical pharmacists ensured clinical rational use of drugs and improved clinical efficacy. Conclusion: The clinical pharmacists have played a professional knowledge to assess the nutritional status of patients to develop parenteral nutrition and antibiotics selection, to ensure the clinical efficacy.