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目的:分析临床药师参与典型疑难危重患者的诊治过程,总结药学监护中临床药师应具备的临床及药学思维,以便更好地服务临床工作。方法:通过临床药师参与1例肝脓肿术后高钠血症患者并发脱髓鞘病变案例的诊疗过程,结合患者实验室检验指标、影像学检查结果和药物治疗方案,判断分析患者病情变化的根本原因和可采取的治疗措施,提出合理的用药建议。结果:临床药师密切关注患者用药史和病情变化,及时评估患者的治疗效果,与临床医师积极沟通和讨论,为患者制定个体化治疗方案,取得了良好的治疗效果。结论:临床药师抓主要矛盾,注重细节,在危重症患者的救治过程中可以发挥重要的作用。
OBJECTIVE: To analyze the clinical pharmacists’ participation in the diagnosis and treatment of typical difficult and critically ill patients and to summarize the clinical and pharmacological thinking that clinical pharmacists should have in order to better serve the clinical work. Methods: The clinical pharmacist involved in the diagnosis and treatment of one case of demyelinating lesions of patients with hypernatremia after hepatic abscess, combined with the laboratory test indicators, imaging findings and drug treatment programs, to determine the analysis of the patient’s condition changes Reasons and treatment measures can be taken to make reasonable recommendations for medication. Results: The clinical pharmacists paid close attention to the medication history and the changes of patients’ condition, timely evaluated the therapeutic effect of the patients, actively communicated and discussed with the clinicians, and formulated individualized treatment plans for the patients with good therapeutic effects. Conclusion: Clinical pharmacists focus on the main contradictions, attention to detail, in the treatment of critically ill patients can play an important role.