1.Department of Clinical Pharmacy, Shanghai First People′s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201620, China； 2.Department of Pharmacy, Zhenjiang Hospital of Chinese Traditional and Western Medicine, Jiangsu Province, Zhenjiang 212000, China
Abstract：The extracorporeal membrane oxygenation(ECMO) technique is an important method of extracorporeal life support for patients in Intensive Care Unit (ICU), the drug rational use and pharmaceutical care of patients with pneumonia during ECMO were less reported. This manuscript reported one patient with severe pneumonia treated by ECMO and anti-infection, anti-virus, and asthma phlegm and supported treatment, symptoms and body temperature of the patient got improved, but the body temperature rose again on the 6th day, culture of alveolar lavage yielded acinetobacter baumannii, pseudomonas aeruginosa. After following the suggestion of the clinical pharmacist, tigecycline, cefopcrazone- sulbactam, compound sulfamethoxazole were given gradually, after treatment for 12 days the patient was keeping in a stable condition. In the process of treatment, a skin rash appeared on the patients′ both arms on 8th day. With clinical pharmacists′ consultation, dexamethasone, vitamin C, loratadine were prescript and the symptoms were improved after treatment. whole process of drug treatment of a severe pneumonia patient with ECMO was participated in clinical pharmacist. Through familiar with condition change of the patient in time, combined with auxiliary examination results, analyzing drug sensitive tests with bacterial culture result, consulting the related literature, the clinical pharmacist could put forward reasonable suggestions, implement comprehensive pharmaceutical care on the selection of antimicrobial treatment scheme, antibacterial drug dosage and announcements under ECMO, pharmaceutical analysis and treatment measures when drug eruption appeared. It is important for establishing individualized regimen, improving the effectiveness and safety of drug treatment in patients.
[1] 刘松桥，邱海波.ECMO临床应用及进展[J].中华医学信息导报，2015，30（5）：16-17.
[2] Ha MA，Sieg AC. Evaluation of altered drug pharmacokinetics in critically Ⅲ adults receiving extracorporeal membrane oxygenation [J]. Pharmacotherapy，2017，37，（2）：221-235.
[3] Sherwin J，Heath T，Watt K. Pharmacokinetics and dosing of anti-infective drugs in patients on extracorporeal membrane oxygenation：a review of the current literature [J]. Clin Ther，2016，38（9）：1976-1994.
[4] 徐思露，邵华，胡琳璘，等.体外膜肺氧合对抗菌药物药代动力学影响的研究进展[J].中国临床药理学杂志，2017， 33（4）：376-380，384.
[5] De Rosa FG，Corcione S，Baietto L，et al. Pharmacokinetics of linezolidduring extracorporeal membrane oxygenation [J]. Int J Antimicrob Agents，2013，41（6）：590-591.
[6] Wright DH，Brown GH，Peterson ML，et al. Application of fluoroquinolone pharmacodynamics [J]. J Antimicrob Chemo?鄄ther，2000，46（5）：669-683.
[7] Wishart DS，Knox C，Guo AC，et al. DrugBank：a comprehensive resource for in silico drug discovery and exploration [J]. Nucleic Acids Res，2006，34（Database issue）：D668-672.
[8] Lemaitre F，Luyt CE，Roullet-Renoleau F，et al. Impact of extracorporeal membrane oxygenation and continuous venovenous hemodia?覱ltration on the pharmacokinetics of oseltamivir carboxylate in critically ill patients with pandemic（H1N1）influenza [J]. Ther Drug Monit，2012，34（2）：171-175.
[9] Kalil AC，Metersky ML，Klompas M，et al. Executive summary：management of adults with hospital-acquired and ventilator-associated pneumonia： 2016 clinical practice guidelines by the infectious diseases society of America and the American Thoracic Society [J]. Clin Infect Dis，2017， 64（9）：1298-1298.
[10] 李春辉.MDR、XDR、PDR多重耐药菌暂行标准定义——国际专家建议[J].中国感染控制杂志，2014，13（1）：62-64.
[11] 王国恩，马琪，刘敏龙，等.ICU病房鲍曼不动杆菌感染状况及耐药性分析[J].中国医药导报，2015，（27）：153-155.
[12] 陈佰义，何礼贤，胡必杰，等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中华医学杂志，2012，92（2）：76-85.
[13] 中华医学会呼吸病学分会感染学组.铜绿假单胞菌下呼吸道感染诊治专家共识[J].中华结核和呼吸杂志，2014， 37（1）：9-15.
[14] 王立兰，安儒峰. 2012～2014年铜绿假单胞菌耐药性变迁及抗菌药物应用分析[J].中国现代医生，2015，53（35）：70-73，76.
[15] 匡凯英，方红.药疹发病机制研究概述[J].浙江医学，2003，25（11）：700-702.
[16] 林静，董秀芹.重症药疹41例临床分析[J].中国医药导报，2016，13（11）：134-137.
[17] Rodriguez- Pena R，Lopez S，Mayorga C，et al. Potential involvement of dendritic cells in delayed hypersensitivity reactions to B- lactams [J]. J Allergy Clin Immunol，2006， 118（4）：949-956.
[18] Varghese ST，Balhara YPS，Shyamsunder，et al. Dermatological side effects of olanzapine [J]. Indian J Med Sci，2005，59（7）：320-321.
[19] 王芳，李毓，莫莹，等.药疹临床类型和致敏药谱最近七年与过去十年的对比变化[J].实用医学杂志，2011，27（21）：3932-3934.
[20] 孙薇，仲光.替加环素致重症药疹1例[J].临床肺科杂志，2015，（1）：187-188.
2017, Vol. 14 
京公网安备 11010502046598号