以VDP方案为基础的诱导治疗用于急性淋巴细胞白血病患者的药学服务

Pharmaceutical care for patients with acute lymphoblastic leukemia by induction therapy based on VDP regimen

目的探讨临床药师在血液肿瘤患者治疗实践中的作用。方法对上海交通大学附属第一人民医院血液科2015年1月-2016年4月收治的12例急性淋巴细胞白血病患者进行研究．这些患者接受了以长春新碱或长春地辛、蒽环／蒽醌类药物、糖皮质激素为基础的方案（VDP）诱导治疗，或联合使用环磷酰胺（CTX），或联合使用注射用培门冬酶（PEG—Asp），从不良反应的预防、监测和处理等方面着手，考察患者的肝肾功能、心脏功能、消化道反应、神经毒性等指标，介绍药学服务的过程。结果临床药师权衡利弊，采取恰当的措施有效预防和干预临床治疗，2例肝功能损伤患者经保肝降酶治疗恢复正常，3例出现消化道反应患者经对症治疗和心理疏导后得以缓解，对2例轻度神经毒性的患者除密切观察外未作药物干预，全部病例未出现药物性心脏功能、肾功能损伤。结论临床药师对化疗方案的全面、细致药学服务，完善了患者的个体化治疗方案，减轻了不良反应的发生，提高了临床疗效。

Objective To investigate the role of clinical pharmacist in the treatment of patients with blood cancer. Methods 12 cases of induction therapy on acute lymphoblastic leukemia were collected in Department of Hematology of Shanghai Jiao Tong University Affiliated First People＇s Hospital. These patients were treated with vincristine/vindesine, anthracycines/anthraquinones, glucocorticoids （named VDP regimen）, combined with cyclophosphamide or PEG- aspargase. In terms of prevention, monitoring and treatment of adverse reactions, liver and kidney function, heart function, gastrointestinal reaction and neurotoxicity were investigated and the whole process of pharmaceutical care was introduced. Results Clinical pharmacist assessed the benefits and potential risks thoroughly, took appropriate measures to prevent and interfere clinical treatment effectively. Two patients with liver function injury returned to normal after giving liver-protective drugs, three patients with side effects of digestive tract relieved after symptomatic treatment and psychological counseling, two patients with mild neurotoxicity were not taken any drug therapy except close observation. All patients did not show druginduced cardiac and renal function injury. Conclusion Clinical pharmacist plays an important role in adopting comprehensive and detailed pharmaceutical care of chemotherapy regimen, reducing adverse reaction and accomplishing individual treatment.