1例小细胞肺癌患者化疗的药学监护
|
摘要
目的:探讨临床药师对化疗患者进行药学监护的方法,促进合理用药。方法:针对1例小细胞肺癌化疗患者,临床药师分析化疗方案,提供药学监护。结果:该患者的化疗方案为伊立替康联合顺铂,药品不良反应的发生率较高,临床药师及时地制订和调整化疗方案,合理地应用药物预防方案,避免了更严重不良反应的发生;对化疗过程中出现的骨髓抑制、严重腹泻、肠梗阻等问题,结合患者病情,依据相关治疗指南及临床药学知识,与临床医师共同讨论和实施升高白细胞、止泻及胃肠减压等用药方案,根据疗效及时调整用药,使肿瘤患者顺利完成化疗周期。结论:临床药师应深入临床,参与患者治疗全过程,密切配合医师监测患者各项临床指标,协助制定治疗方案,并对患者进行用药指导,以促进临床安全、有效用药。
OBJECTIVE: To explore the approaches for clinical pharmacist to carry out pharmaceutical care for patient receiving chemotherapy so as to promote rational use of drug. METHODS: Clinical pharmacist analyzed the chemotherapy regimen and provided pharmaceutical care for one patient with small cell lung cancer( SCLC). RESULTS:The chemotherapy regimen consisted of irinotecan and cisplatin; due to the high incidence of adverse drug reactions,clinical pharmacist timely formulated and adjusted the chemotherapy,reasonably applied the chemoprophylaxis programs,which helped avoid the occurrence of more serious adverse reactions; clinical pharmacist discussed the problems noted during chemotherapy such as bone marrow suppression,severe diarrhea,intestinal obstruction etc with clinicians based on patients' condition taking the related treatment guideline and clinical pharmaceutical knowledge as references,carried out a series of schemes to increase white blood cell count,check diarrhea and achieve gastrointestinal decompression,adjusted drug use based on efficacy,which facilitated cancer patients' smooth completion of periodical chemotherapy.CONCLUSIONS: Clinical pharmacists‘involvement in patients' clinical treatment by closely cooperate with physicians to monitor patients' clinical indicators,make therapeutic regimens,provide medication guidance among patients contributed to patients' safe and effective medication.
OBJECTIVE: To explore the approaches for clinical pharmacist to carry out pharmaceutical care for patient receiving chemotherapy so as to promote rational use of drug. METHODS: Clinical pharmacist analyzed the chemotherapy regimen and provided pharmaceutical care for one patient with small cell lung cancer( SCLC). RESULTS:The chemotherapy regimen consisted of irinotecan and cisplatin; due to the high incidence of adverse drug reactions,clinical pharmacist timely formulated and adjusted the chemotherapy,reasonably applied the chemoprophylaxis programs,which helped avoid the occurrence of more serious adverse reactions; clinical pharmacist discussed the problems noted during chemotherapy such as bone marrow suppression,severe diarrhea,intestinal obstruction etc with clinicians based on patients' condition taking the related treatment guideline and clinical pharmaceutical knowledge as references,carried out a series of schemes to increase white blood cell count,check diarrhea and achieve gastrointestinal decompression,adjusted drug use based on efficacy,which facilitated cancer patients' smooth completion of periodical chemotherapy.CONCLUSIONS: Clinical pharmacists‘involvement in patients' clinical treatment by closely cooperate with physicians to monitor patients' clinical indicators,make therapeutic regimens,provide medication guidance among patients contributed to patients' safe and effective medication.
引文
[1]范云.中国临床肿瘤学进展[M].北京:人民卫生出版社,2010:70-74.
[2]伍志新,陈立军,宋文军,等.伊立替康联合洛铂治疗复发性广泛期小细胞肺癌(SCLC)的临床研究[J].现代肿瘤医学,2014,22(6):1344-1346.
[3]邵岚,张沂平.复发性小细胞肺癌治疗进展[J].国际肿瘤学杂志,2012,39(5):374-376.
[4]钱南萍,魏润新,许静,等.临床药师对肿瘤科药物治疗的药学监护[J].中国药房,2011,22(10):954-956.
[5]Amarasena IU,Walters JA,Wood-Baker R,et al.Platinum versus non-platinum chemotherapy regimens for small cell lung cancer[J].Cochrane Database Syst Rev,2008(4):CD006849.
[6]Zatloukal P,Cardenal F,Szczesna A,et al.A multicenter international randomized phaseⅢstudy comparing Cisplatin in combination with Irinotecan or Etoposide in previously untreated small-cell lung cancer patients with extensive disease[J].Ann Oncol,2010,12(9):1810-1816.
[7]张楠.伊立替康联合顺铂治疗小细胞肺癌疗效观察研究[D].浙江大学,2012:1-52.
[8]王育琴,李玉珍,甄健存,等.医院药师基本技能与实践[M].北京:人民卫生出版社,2013:212-214.
[9]杨琳,范芳,谢瑞祥.伊立替康浓度测定及其输液稳定性考察[J].海峡药学,2009,21(11):49-50.
[10]屈元娇,刘陶文,徐李容,等.肿瘤化疗后中性粒细胞缺乏症20例临床分析[J].现代肿瘤医学,2010,18(1):156-158.
[11]陈宇,陈勤奋.白细胞生长因子的合理应用——美国临床肿瘤学会白细胞生长因子应用指南简介及体会[J].上海医药,2009,30(9):391-393.
[12]陈斌,翁琳,王增.化疗引起Ⅳ度骨髓抑制的临床观察与分析[J].中国药房,2010,21(14):1310-1312.
[13]李子明,唐晓春,陈智伟.伊立替康在广泛期小细胞肺癌化疗中的应用[J].肿瘤,2009,29(7):696-699.
[14]庞艳玲,吕芳芳,贺永军,等.化疗相关性腹泻的治疗与护理[J].中国医药导报,2013,10(15):157-158,161.
[15]Vinolas N,Molina R,Galán MC,et al.Tumor markers in response monitoring and prognosis of non-small cell lung cancer:preliminary report[J].Anticancer Res,1998,18(1B):631-634.
[2]伍志新,陈立军,宋文军,等.伊立替康联合洛铂治疗复发性广泛期小细胞肺癌(SCLC)的临床研究[J].现代肿瘤医学,2014,22(6):1344-1346.
[3]邵岚,张沂平.复发性小细胞肺癌治疗进展[J].国际肿瘤学杂志,2012,39(5):374-376.
[4]钱南萍,魏润新,许静,等.临床药师对肿瘤科药物治疗的药学监护[J].中国药房,2011,22(10):954-956.
[5]Amarasena IU,Walters JA,Wood-Baker R,et al.Platinum versus non-platinum chemotherapy regimens for small cell lung cancer[J].Cochrane Database Syst Rev,2008(4):CD006849.
[6]Zatloukal P,Cardenal F,Szczesna A,et al.A multicenter international randomized phaseⅢstudy comparing Cisplatin in combination with Irinotecan or Etoposide in previously untreated small-cell lung cancer patients with extensive disease[J].Ann Oncol,2010,12(9):1810-1816.
[7]张楠.伊立替康联合顺铂治疗小细胞肺癌疗效观察研究[D].浙江大学,2012:1-52.
[8]王育琴,李玉珍,甄健存,等.医院药师基本技能与实践[M].北京:人民卫生出版社,2013:212-214.
[9]杨琳,范芳,谢瑞祥.伊立替康浓度测定及其输液稳定性考察[J].海峡药学,2009,21(11):49-50.
[10]屈元娇,刘陶文,徐李容,等.肿瘤化疗后中性粒细胞缺乏症20例临床分析[J].现代肿瘤医学,2010,18(1):156-158.
[11]陈宇,陈勤奋.白细胞生长因子的合理应用——美国临床肿瘤学会白细胞生长因子应用指南简介及体会[J].上海医药,2009,30(9):391-393.
[12]陈斌,翁琳,王增.化疗引起Ⅳ度骨髓抑制的临床观察与分析[J].中国药房,2010,21(14):1310-1312.
[13]李子明,唐晓春,陈智伟.伊立替康在广泛期小细胞肺癌化疗中的应用[J].肿瘤,2009,29(7):696-699.
[14]庞艳玲,吕芳芳,贺永军,等.化疗相关性腹泻的治疗与护理[J].中国医药导报,2013,10(15):157-158,161.
[15]Vinolas N,Molina R,Galán MC,et al.Tumor markers in response monitoring and prognosis of non-small cell lung cancer:preliminary report[J].Anticancer Res,1998,18(1B):631-634.