临床药师基于循证方法对1例晚期肺癌脑转移患者的药学监护

Pharmaceutical Care for a Patient with Advanced Lung Cancer Complicating with Brain Metastasis by Clinical Pharmacists with Evidenced-based Method

目的:通过临床药师基于循证方法对1例肺癌伴脑转移患者实施药学监护,探讨临床药师如何应用文献证据为临床提供治疗建议,更好地发挥临床药师的作用。方法:临床药师在1例肺癌伴脑转移患者的药学监护过程中,在充分评估患者情况后,通过检索Pub Med、CNKI数据库,选择高证据等级的文献作为评价患者用药方案的依据。首先评估了患者使用吉非替尼靶向治疗方案的预期收益;其次依据癌症支持治疗多国协会(MASCC)指南就吉非替尼可能出现的不良反应提出了预防措施;再次通过各类药学检索工具发现和预防了利培酮和昂丹司琼合用可能发生的不良反应。结果:医师在靶向药物选择、不良反应预防以及用药方案调整等方面均采纳了临床药师的建议,避免了抗精神病药与止吐药合用出现的严重不良反应;积极采取预防措施,使吉非替尼引发皮疹的严重程度大幅减少,从而保证了患者治疗过程顺利;患者脑转移症状最终得以控制,顺利出院。结论:以循证药学为基础的药学监护,使药师和医师在药物治疗方面更容易达成共识,同时也保证了药学监护工作的科学性和可靠性。

OBJECTIVE： To explore the way to provide suggestion for clinical treatment by clinical pharmacists using docu- mentary evidence so as to play the role of clinical pharmacists, by providing evidenced-based pharmaceutical care for a patient with lung cancer complicating with brain metastasis. METHODS： Clinical pharmacists monitored the whole treatment process of a pa- tient with lung cancer complicating with brain metastasis; after evaluating the condition of patient, retrieved from PubMed and CNKI periodical database, high-level evidence literature were selected for the evaluation evidence of medical scheme. Firstly, the expected revenue of gefitinib targeted treatment was evaluated; secondly, the prevention measures of gefitinib-induced ADR were put forward according to MASCC; thirdly, potential ADR of risperidone combined with ondansetron were found and prevented by various pharmacy retrieval tools. RESULTS： The physicians took the advice of clinical pharmacist in selection of targeted drug, ADR prevention and the adjustment of drug therapy, to avoid severe ADR using antipsychotic drug combined with antimetic drug. Prevention measures were adopted actively to relieve the gefitinib-induced rash greatly and guarantee the treatment of patients. The brain metastasis was relieved and then the patient was discharged from hospital successfully. CONCLUSIONS： The evidence-based pharmaceutical care assists physicians and phanllacist to formulate an agreement on drug treatment, and guarantee the scientifical- ness and reliability of pharmaceutical care.