于丽+王高彪+郭丽萍

摘 要 目的：探讨临床药师进行药学会诊中的思维过程，为临床药师参与抗感染治疗提供参考依据。方法：临床药师参与气管切开术后致泛耐药鲍曼不动杆菌肺部感染会诊，向临床医师提出个体化用药建议，并对用药全程做好监护，分析会诊思维过程。结果：治疗效果明显，治疗过程中无明显药物不良反应发生。结论：临床药师运用临床药学思维，参与治疗过程，对提高疗效、保障患者安全有着积极的作用。

关键词 泛耐药鲍曼不动杆菌 临床药师 抗感染治疗

中图分类号：R517.9 文献标识码：C 文章编号：1006-1533（2016）15-0071-04

The role of clinical pharmacists in the treatment of pulmonary infection caused by pan-drug resistant A. baumannii

YU Li*， WANG Gaobiao， GUO Liping

（The Seventh Peoples Hospital of Zhengzhou City， Zhengzhou 450016， China）

ABSTRACT Objective： To discuss the thinking process of clinical pharmacists in pharmaceutical care and to provide a reference for clinical pharmacist to participate in anti-infection treatment during clinical practice. Methods： Clinical pharmacist participated in a consultation for the treatment of a case of pulmonary infection caused by pan-drug resistant A. baumannii and provided an individualized medication suggestion for doctors， and meanwhile monitored the entire course of medication for the patient. The thinking process of pharmaceutical consultation was further analyzed. Results： The effectiveness for the treatment of this case was evident， and no obvious adverse drug reactions occurred in the therapeutic process. Conclusion： Clinical pharmacists participating in the treatment process by using their clinical thoughts can play a positive role in improving the curative effect and ensuring the safety of patient medication.

KEY WORDS pan-drug resistant A. baumannii； clinical pharmacist； anti-infection treatment

鲍曼不动杆菌（Acinetobacter baumannii，A. baumannii）是一种非发酵性革兰阴性杆菌，在自然界和医院环境广泛存在，并能在人体多部位定植，是医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）的重要致病菌[1]。气管切开为一种侵入性操作，易使患者呼吸道黏膜破坏，导致气道与外部环境直接相通，从而发生肺部感染[2]。由于机械通气导致原在气道内和呼吸机定植的鲍曼不动杆菌直接进入肺部，成为气管切开术后患者肺部感染的重要病原菌[3]。随着抗菌药物的广泛应用，鲍曼不动杆菌耐药菌株日益增多，泛耐药鲍曼不动杆菌在临床分离率明显增加，给临床治疗带来很大困难。本文为临床药师参与气管切开术后发生泛耐药鲍曼不动杆菌肺部感染患者的治疗分析，探讨临床药师在患者治疗中的作用。

1 病史摘要

患者，男性，66岁。因“脑出血术后间断发热、咳嗽1个月，加重3 d”入院。……