Page 122 - 2020年21期

·药师与药学服务·

临床药师对1例婴幼儿肠套叠穿孔术后抗感染治疗方案的优化 Δ

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苏长海 ，刘俊保 ，解沛涛 ，郝 朵 ，张晓娟（1.鄂尔多斯市中心医院药剂科，内蒙古 鄂尔多斯 017000；2.内
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蒙古自治区人民医院药剂科，呼和浩特 010017）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2020）21-2672-05
DOI 10.6039/j.issn.1001-0408.2020.21.19

摘 要 目的：为肠套叠穿孔术后感染的婴幼儿患者的抗感染个体化治疗提供思路，为临床药师参与临床疾病的治疗提供参考。
方法：临床药师对鄂尔多斯市中心医院收治的1例肠套叠穿孔术后感染的11个月龄患儿的抗感染方案进行优化，针对该患儿的初
始抗感染治疗方案的选择，药物的更换以及血培养回报大肠埃希菌与屎肠球菌后的抗感染方案选择以及剂量调整等方面提出用
药建议。结果：根据对患儿肠套叠穿孔术后感染常见致病菌以及属于院内或者社区感染的判断，临床药师将头孢哌酮钠舒巴坦钠
1.0 g，q12 h调整为头孢哌酮钠舒巴坦钠0.5 g，q8 h，联合甲硝唑氯化钠注射液20 mL，q8 h；当血培养回报为大肠埃希菌（超广谱β-
内酰胺酶阴性）与屎肠球菌后，临床药师建议加用万古霉素0.15 g，q12 h；治疗效果不佳后，临床药师建议调整万古霉素剂量为0.2
g，q8 h。医师对上述建议均采纳。患儿经治疗后体温下降、血培养转阴、实验室指标恢复正常，顺利出院。结论：婴幼儿患者为特
殊人群，因此在使用抗菌药物治疗前，临床药师应评估患儿的年龄、体质量、肝肾功能，同时结合药物自身药动学特点以及安全性，
协助医师选择、调整药物以及给药频次和剂量，在保证疗效的同时，避免不良反应的发生。
关键词 婴幼儿；肠套叠；肠穿孔；腹腔感染；抗感染；临床药师

Optimization of Anti-infective Program after Surgery for a Case of Infant Patient with Intussusception and
Enterobrosis by Clinical Pharmacists
SU Changhai ，LIU Junbao ，XIE Peitao ，HAO Duo ，ZHANG Xiaojuan（1. Dept. of Pharmacy，Ordos Central
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Hospital，Inner Mongolia Ordos 017000，China；2. Dept. of Pharmacy，People’s Hospital of Inner Mongolia
Autonomous Region，Hohhot 010017，China）
ABSTRACT OBJECTIVE：To provide the ideas and for individualized anti-infective treatment of infection after surgery for
infants and young children with intussusception and enterobrosis，and to provide reference for clinical pharmacists participating in
the clinical treatment. METHODS：Clinical pharmacists optimized the anti-infection program for an 11-month-old infant patient
infected after surgery with intussusception and enterobrosis in Ordos Central Hospital；they put forward medication suggestions in
respects of the selection of initial anti-infection treatment program，drug replacement，the selection of anti-infection treatment
program after blood culture showed Enterococcus coli and Enterococcus faecium，and dosage adjustment. RESULTS：According to
the judgment of the common pathogens and the hospital or community infections in the infant patient with intussusception and
enterobrosis，cefoperazone sulbactam 1.0 g，q12 h was adjusted to cefoperazone sulbactam 0.5 g，q8 h combined with Metronidazole
chloride sodium injection 20 mL，q8 h；when the blood culture showed E. coli（ESBL-）and E. faecium，it was recommended to
add vancomycin 0.15 g，q12 h. After poor treatment，it was recommended to adjust the vancomycin dose to 0.2 g，q8 h. All the
above suggestions were adopted by doctors. And the child’s body temperature dropped after treatment，the blood culture turned
negative and laboratory indicators returned to normal. The child was discharged smoothly. CONCLUSIONS：Infants and young
children are special groups. Therefore，before using antibiotics，clinical pharmacists should evaluate the age，body weight，liver
and kidney functions of infants and young children. They should also help doctors select and adjust drugs，frequency and dosage on
the basis of pharmacokinetic characteristics and safety，so as to avoid adverse drug reactions while ensure curative effect.
KEYWORDS Infant；Intussusception；Enterobrosis；Abdominal infection；Anti-infection；Clinical pharmacists

[1]
婴幼儿的结肠壁薄，无明显结肠带与脂肪垂，升结 肠及直肠与后腹壁固定较差，极易发生肠套叠 。婴幼
儿肠套叠在我国发病率较高，占婴儿肠梗阻发病率的首
Δ 基 金 项 目 ：内 蒙 古 自 治 区 自 然 科 学 基 金 资 助 项 目（No.
位，其发生率在1岁以下儿童患者中大约为50/100 000，
2017BS0808）
[2]
＊主任药师，博士。研究方向：临床药学。电话：0477-8119366。 且男孩发病率较女孩高，男女之比约为（2～3）∶ 1 。肠
E-mail：2456559698@qq.com 套叠分为原发性与继发性两类，婴幼儿肠套叠几乎均为

·2672 · China Pharmacy 2020 Vol. 31 No. 21 中国药房 2020年第31卷第21期