1例晚期肺腺癌患者抗肿瘤及营养支持治疗的药学监护.pdfVIP

中国药物应用与监测2011年8月第8卷第4期 Chinese Journal of Drug Application and Monitoring, Vol.8, No.4, August 2011 ·临床药师园地 · 1例晚期肺腺癌患者抗肿瘤及营养支持治疗的药学监护 1,2 1 （1. 解放军总医院药品保障中心，北京 100853 ；2. 山西省临汾市人民医院药剂科，山西 临汾 04 1000 ） 张瑞芬 ，朱　曼 [摘要] 1例52 岁女性患者，因肺腺癌、放射性食管炎入院治疗，入院后给予厄洛替尼、奥美拉唑、肠外营养支持等治疗。临 床药师对治疗方案进行分析，将奥美拉唑对厄洛替尼溶解度的影响、奥美拉唑与H2 受体拮抗剂对胃内pH 的抑酸作用、肠外 营养中各要素的配比要求进行归纳总结，建议充分考虑奥美拉唑对厄洛替尼抗肿瘤药效的影响，停用厄洛替尼；并针对肿瘤 患者营养需求特点，优化肠外营养医嘱；治疗37 d 患者病情稳定出院。 [关键词] 临床药师；药学监护；药物相互作用；肠外营养；奥美拉唑；厄洛替尼 [ 中图分类号] R972 [文献标识码] A [文章编号] 1672 – 8157(2011)04 – 0216 – 03 Pharmaceutical care on a patient with lung adenocarcinoma for anti-tumor and nutrition support ZHANG Rui-fen1,2, ZHU Man1 ( 1. Department of Pharmaceutical Care, PLA General Hospital, Beijing 100853, China; 2. Department of Pharmacy, Linfen Peoples Hospital, Linfen 041000, China ) [ABSTRACT] One 52-year-old female patient with lung adenocarcinoma and radioactive esophagitis was admitted to hospital. After admission, erlotinib, omeprazole and parenteral nutrition support therapy were given. Clinical pharmacists analyzed therapeutic schemes, and summarized the impact of omeprazole on the solubility of erlotinib, the role of omeprazole and H2 receptor antagonists on intragastric acid suppression, and the ratio of the requirements of elements in parenteral nutrition. Clinical pharmacists made recommendations with regard to the impact of omeprazole on antitumor effect of erlotinib, afterward physician in charge terminated use of erlotinib timely. In view of characteristics of nutritional needs for cancer patients, clinical pharmacists optimized the prescription of parenteral nutrition. After 37 days of the therapy, the patient was discharged. [KEY WORDS] Clinical pharmacist; Pharmaceutical care; Drug interactions; Parenteral nutrition; Omeprazole; Erlotinib 晚期肺腺癌的药物治疗主要为多西他赛等单药 出现吞咽困难伴腹胀，复查肺CT 提