1例痛风石破溃继发化脓性关节炎合并脓毒血症 病例的治疗与监护

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【中图分类号】R97 【文献标识码】A

【Abstract】This article retrospectively analyzed the involvement of clinical pharmacists in the treatment process and implementation of pharmacological supervision in a patient with septic arthritis secondary to tophi ulceration.The patient was admitted to the hospital and the emergency debridement and tophi removal were performed. Piperacillin-tazobactam，imipenem cilastatin，levofloxacin，linezolid，and vancomycin were given successively，and multiple debridementand drainage were performed，but the patient remained febrile and had recurrent infection indicators.According to the relevant guidelines and evidence-based evidence，combined with the patient's infection indicators，pathogen results and creatinine clearance rate， the clinical pharmacists recommended stopping vancomycin and changing to cefazolin，and the clinicians adopted it. After that， the patient's inflammatory indicators gradually decreased，and the body temperature stabilized. After 28 days of piperacilin-tazobactam administration，the patient developed a reduction in white blood cell count （2.34×109⋅L-1） and potassium （2.98mmol⋅L-1 ）. The pharmacist recommended prompt discontinuation of the drug，and the patient's white blood cell countand potassium gradually recovered.Eventually，after anti-infective treatment and surgical intervention，the patient was discharged with closure of the infected foci，conversionof multiple blood cultures to negative，and stabilisation of body temperature and renal function. This case reflects the role of clinical pharmacists in the management of drug treatment of criticallyillpatients，and may provide practical experience and reference for clinical treatment of such cases.

【Keywords】Gout stones; Suppurative arthritis; Sepsis; Pharmaceutical care; Methicillin-sensitive Staphylococcus aureus

痛风性关节炎通常由尿酸盐结晶在关节腔内沉积引起，导致急性炎症反应[1l，而化脓性关节炎则是由细菌感染引起的关节内化脓性炎症，是一种骨科急症，可导致患者数天内骨骼、软骨和周围软组织严重破坏，需及时诊断和治疗[2-3]糖尿病、风湿性关节炎、痛风、使用免疫抑制剂是化脓性关节炎的危险因素[4，近期菌血症也是其危险因素之一[4。（剩余12016字）