Page 105 - 《中国药房》2021年23期

临床药师对难治性嗜麦芽窄食单胞菌脓毒血症患儿的药学监护 Δ

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陈 辞 ，李 卓 ，阳 波 ，王胜峰 （1.南华大学衡阳医学院/南华大学附属第一医院药学部，湖南 衡阳
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421001；2.中南大学湘雅三医院药学部，长沙 410013）
中图分类号 R969.3；R725.9 文献标志码 A 文章编号 1001-0408（2021）23-2911-06
DOI 10.6039/j.issn.1001-0408.2021.23.17

摘 要 目的：探讨临床药师在儿童难治性嗜麦芽窄食单胞菌脓毒血症治疗中的药学监护，为该病患儿的治疗提供参考。方法：
临床药师参与难治性嗜麦芽窄食单胞菌脓毒血症患儿的诊疗过程。根据患儿的病理生理特点及抗菌药物的药动学/药效学特性，
临床药师建议抗感染方案调整为头孢哌酮钠舒巴坦钠160 mg/（kg·d），每8 h 给药1次+左氧氟沙星10 mg/kg，每12 h 给药1次；针
对患儿全身炎症反应重的临床表现，临床药师建议加用甲泼尼龙琥珀酸钠1 mg/kg，每12 h 给药1次抗炎辅助治疗；同时，临床药
师在整个治疗过程中对患儿进行个体化用药监护（包括头孢哌酮钠舒巴坦钠血药浓度监测、不良反应监测以及氧气雾化给药教育
等），并对患儿随访1年。结果：医师采纳临床药师的建议。患儿的脓毒血症得以控制，病情好转予以出院；随访中患儿未出现软
骨及关节损伤等不良反应。结论：免疫力低下、入住重症监护病房时间长、气管插管、恶性肿瘤等是嗜麦芽窄食单胞菌感染的高危
因素。头孢哌酮钠舒巴坦钠的治疗药物监测在儿童重症感染治疗中非常必要，权衡利弊、满足一定条件后，儿童可以使用喹诺酮
类抗菌药物抗感染；在有效的抗感染治疗下，小剂量糖皮质激素可减轻脓毒血症患儿全身炎症反应。
关键词 儿童；难治性；嗜麦芽窄食单胞菌；脓毒血症；药学监护

Pharmaceutical Care for a Child with Refractory Stenotrophomonas maltophilia Sepsis by Clinical
Pharmacist
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CHEN Ci ，LI Zhuo ，YANG Bo ，WANG Shengfeng（1. Hengyang Medical School，University of South China/
Dept. of Pharmacy，the First Affiliated Hospital of University of South China，Hunan Hengyang 421001，
China；2. Dept. of Pharmacy，the Third Xiangya Hospital of Central South University，Changsha 410013，
China）
ABSTRACT OBJECTIVE：To investigate the pharmaceutical care for a child with refractory Stenotrophomonas maltophilia sepsis
by clinical pharmacists，and to provide reference for the treatment of children with this disease. METHODS：Clinical pharmacist
participated in drug therapy for a child with refractory S. maltophilia sepsis. Based on the pathophysiological characteristics of the
child and the PK/PD characteristics of the antimicrobials，clinical pharmacists suggested that the anti-infection regimen should be
adjusted as cefoperazone sodium and sulbactam sodium 160 mg/（kg·d），every 8 hours combined with levofloxacin 10 mg/kg，
every 12 hours. For clinical manifestations of severe inflammatory reaction， the clinical pharmacist suggested receiving
methylprednisolone sodium succinate 1 mg/kg additionally，every 12 hours，for anti-inflammatory adjuvant therapy. At the same
time， clinical pharmacist provided individualized pharmaceutical care （including the detection of blood concentration of
cefoperazone sodium and sulbactam sodium，the detection of ADR and medication education of oxygen atomization）during the
treatment，and followed up the child for one year. RESULTS：The doctors adopted the suggestions of clinical pharmacists. The
sepsis was controlled，the child’s condition were improved and then discharged. During the follow-up，the child did not suffered
from ADR，such as cartilage and joint injury. CONCLUSIONS：Hypoimmunity，long stay in intensive care unit，endotracheal
intubation and malignant tumor are the high risk factors of S. maltophilia infection. The monitoring of therapeutic drugs of
cefoperazone sodium and sulbactam sodium is very necessary in the treatment of severe infection in children. After weighing the
advantages and disadvantages and meeting certain conditions，children can use quinolones for anti-infection；based on the effective
anti-infection treatment，low-dose glucocorticoid can reduce the systemic inflammatory respense in patients with sepsis.
KEYWORDS Children；Refractory；Stenotrophomonas maltophilia；Sepsis；Pharmaceutical care
Δ 基金项目：衡阳市科技计划项目（No.2020jh042756）；湖南省医
学会医学科研基金-临床药学项目（No.HMA202001011）
嗜麦芽窄食单胞菌（Stenotrophomonas maltophilia）
＊主管药师，硕士。研究方向：小儿用药。电话：0734-8578928。
是一种低毒力、非发酵革兰氏阴性杆菌，广泛存在于自
E-mail：chenci871221@163.com
# 通信作者：主管药师，博士。研究方向：小儿用药。电话：0731- 然界中。近年来，随着广谱抗菌药物的广泛使用以及气
88618458。E-mail：75789702@qq.com 管插管等侵入性操作的增加，该菌逐渐成为院内感染主

中国药房 2021年第32卷第23期 China Pharmacy 2021 Vol. 32 No. 23 ·2911 ·