对1例晚期直肠癌患者的药学监护.pdfVIP

中国药物应用与监测 2010年4月第7卷第2期 Chinese Journal of Drug Application and Monitoring, Vol.7, No.2, April 2010 对1 例晚期直肠癌患者的药学监护 1 1 2 （1. 山东大学齐鲁医院药剂科，山东 济南 250012 ；2. 山东大学齐鲁医院肿瘤科，山东 济南 250012 ） 方英立 ，崔 晶 ，王秀问 [摘要] 1例27 a 女性患者，直肠癌姑息术后，4 周期OLF 方案化疗2 月余，因疾病进展入院。临床药师指导患者正确服用止 痛、降酶、保肝、抗肿瘤药物，并对伊立替康联合卡培他滨所致的乙酰胆碱综合征、延迟性腹泻、恶心、呕吐、手足综合征及 骨髓抑制的预防和治疗给予监护，并提出合理化建议，同时密切观察患者肝功能，并对患者进行出院指导。 [关键词] 临床药师；药学监护；直肠癌；伊立替康；卡培他滨 [ 中图分类号] R969.3 ；R979.1 [ 文献标识码] A [ 文章编号] 1672 – 8157(2010)02 – 0111 – 03 Pharmaceutical care on a patient with advanced rectal cancer 1 1 2 FANG Ying-li , CUI Jing , WANG Xiu-wen (1. Department of Pharmacy, Qilu Hospital of Shandong University, Jinan 250012, China; 2. Department of Oncology, Qilu Hospital of Shandong University, Jinan 250012, China) [ABSTRACT] A 27-year-old female patient, who had been operated with rectal cancer palliative resection and treated with 4 cycles chemotherapy of OLF for 2 months, was hospitalized for progressive disease. Clinical pharmacist guided the patient correct medication method of analgesics, lowing liver enzyme drugs, liver protectants and anticancer drugs. The liver function and adverse reactions caused by combination chemotherapy with irinotecan and capecitabine, such as acetylcholine syndrome, tardive diarrhoea, nausea and vomiting, hand-foot syndrome and bone marrow suppression, were monitored and rational proposal was suggested for prevention and treatment of those adverse reactions. Patient education for discharging from hospital was also conducted by clinical pharmacist. [KEY WORDS] Clinical pharmacist; Pharmaceutical care; Rectal cancer; Irinotecan; Capecitabine 直肠癌患者有15% ~ 25%会出现同时性肝转移， 日入我院化疗科。既往无其他疾病史。本次住院KPS [1-2] 其中80% ~ 90% 肝转移灶不可切除 。与最佳支持 评分80，体温、大小便、血常规、心电图均正常；肝肾 治疗相比，姑息性化疗在延长患者生存期和提高生