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目的:探讨临床药师在神经外科开展精准药学监护的切入点。方法:临床药师通过参与术后颅内感染的抗感染治疗方案的制定、以基因导向和群体药动学为基础设计苯妥英钠剂量个体化给药方案、分析医嘱找出药物间潜在的不良相互作用等角度开展工作。结果:术后颅内感染的患者,通过临床药师提供精准治疗方案,患者感染常很快得到有效控制;苯妥英钠剂量个体化给药可使其在术后7 d内达到有效治疗浓度;通过分析医嘱避免了苯妥英钠与质子泵抑制剂兰索拉唑、奥美拉唑之间可能存在的不良相互作用。结论:上述3个切入点体现了临床药师开展精准药学监护的内涵,在神经外科治疗团队中发挥了重要作用。
Objective: To explore clinical pharmacists in neurosurgery to carry out precise pharmacy care entry point. Methods: The clinical pharmacists designed individualized dosing regimen of phenytoin sodium based on gene-oriented and population pharmacokinetics by participating in the development of anti-infective therapy for postoperative intracranial infection, and analyzed the doctor’s orders to find potential adverse interactions among the drugs Equal to the work. Results: In patients with postoperative intracranial infection, the clinical pharmacists provided precise treatment programs, and the patient’s infection was often effectively controlled quickly. Individual dose of phenytoin sodium could reach effective therapeutic concentration within 7 days after operation. The doctor’s advice avoids the possible adverse interactions between phenytoin and the proton pump inhibitors lansoprazole and omeprazole. Conclusion: The above three entry points embody the connotation of clinical pharmacists carrying out precise pharmacy supervision and play an important role in neurosurgical treatment team.