目的：通过参与1例药源性中毒性表皮松解症患者的药学治疗实践,体现了临床药师在药源性疾病的识别、处理以及在合并感染治疗中的价值。方法：2019年9月8日鄂尔多斯市中心医院收治1例脑出血后并发严重肺部感染的患者,先后使用头孢哌酮钠舒巴坦钠、替加环素、亚胺培南西司他丁、奥硝唑、阿米卡星等抗感染治疗1月后患者出现了中毒性表皮松解症(Toxic Epidermal Necrolysis ,TEN),继而出现鲍曼不动杆菌和金黄色葡萄球菌菌血症,临床药师结合患者情况及相关文献文献及时的识别该不良反应并处理,针对患者感染提出个体化的治疗建议。结果：临床药师使用特定的ALDEN方法(与常规不良反应评价方法不同)评估引起中毒性表皮松解症(TEN)的药物因果关系的个体评价,协助医师及时停药并建议甲泼尼龙和丙种球蛋白治疗。患者在出现TEN后伴体温升高,1周之内三次不同时期的血培养提示鲍曼不动杆菌和金黄色葡萄球菌,临床药师协助医师判断血培养的价值,建议医师给予利奈唑胺 600mg q12h,全程监护患者情况,经过两周的抗感染治疗,患者皮肤明显好转。结论：临床药师帮助医师识别药源性疾病,并协助医师制定个体化的治疗方案并全程监护,避免了患者再次药源性疾病的发生,充分体现了临床药师在治疗团队中的价值。

Objective: By participating in the pharmaceutical care practice of a patient with drug-induced toxic epidermolysis, the value of clinical pharmacists in the identification and management of drug-induced diseases and in the treatment of co-infections was reflected. Methods: A patient with severe pulmonary infection after cerebral hemorrhage was admitted to Ordos Central Hospital on September 8, 2019. The patient successively developed toxic epidermolysis (TEN) followed by Acinetobacter baumannii and Staphylococcus aureus bacteremia 1 month after anti-infective treatment with cefoperazone sodium and sulbactam sodium, tigecycline, imipenem and cilastatin, ornidazole, and amikacin. Clinical pharmacists timely identify and deal with the adverse reactions in combination with the patient"s condition and relevant literature literature, and put forward individualized treatment recommendations for patient infection. Results: Clinical pharmacists used specific ALDEN methods (different from routine adverse reaction evaluation methods) to assess individual evaluation of drug causality causing toxic epidermolysis (TEN), assisted physicians in timely discontinuation of the drug and recommended methylprednisolone and gamma globulin treatment. The patient developed TEN with elevated body temperature, and blood cultures at three different periods within 1 week revealed Acinetobacter baumannii and Staphylococcus aureus. The clinical pharmacist assisted the physician in judging the value of blood cultures and advised the physician to give linezolid 600 mg q12h and monitor the patient"s condition throughout. After two weeks of anti-infective treatment, the patient"s skin was significantly improved. Conclusion: Clinical pharmacists help physicians to identify drug-induced diseases, and assist physicians to develop individualized treatment plan and monitor the whole process, avoiding the occurrence of drug-induced diseases in patients again, fully reflecting the value of clinical pharmacists in the treatment team.

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