临床药师参与胃肠道双原发性肿瘤合并心脏基础疾病患者化疗的药学实践

Pharmaceutical Care of Chemotherapy for Patients with Double Primary Gastrointestinal Tumors Complicated with Heart Diseases by Clinical Pharmacists

目的:探讨临床药师在伴有心脏基础疾病的胃肠道双原发性肿瘤患者化疗中的作用,探讨其药学监护的切入点及模式。方法:运用循证医学证据指导1例合并心脏基础疾病的胃肠道双原发性肿瘤患者治疗方案的选择,并对患者化疗过程进行药学监护。结果:针对患者病情,临床药师协助临床医师制订了个体化化疗方案,确保了药物治疗的安全和有效。患者已完成4个周期的化疗,且化疗过程中未见明显异常。结论:临床药师参与到肿瘤多学科综合治疗团队中,对伴有基础疾病的肿瘤患者实施全程药学监护,可以保障患者顺利完成化疗。

OBJECTIVE： To probe into the effect of clinical pharmacists in the chemotherapy of patients with double primary gastrointestinal tumors complicated with heart diseases,so as to discuss the entry point and pattern of pharmaceutical care. METHODS： Evidence-based medicine was applied to guide the therapeutic regimen selection in 1 case of patient with double primary gastrointestinal tumor complicated with heart disease, and to conduct pharmaceutical care during the chemotherapy. RESULTS： Aimed at the patient＇s illness,clinical pharmacists gave assistance to clinicians in formulating individualized chemotherapy regimen to ensure the safety and effectiveness of the therapy. The patient had finished 4 cycles of chemotherapy, and no significant abnormality was found.CONCLUCIONS： Clinical pharmacists participate in the oncology multidisciplinary team and carry out full-course pharmaceutical care for tumor patient complicated with underlying diseases,can guarantee the successful completion of the chemotherapy process.