肝癌合并肠梗阻患者疼痛治疗的药学监护

Pharmaceutical care on pain treatment in a patient with liver cancer complicated with ileus

1例47岁男性患者,肝恶性肿瘤(术后),主因“肠梗阻伴重度疼痛”入院。根据WHO三阶梯镇痛原则,临床药师分析了禁食水状态下阿片未耐受患者癌痛的初始治疗药物品种和剂量选择,协助医师优化镇痛方案,并对癌性爆发痛的处理提出建议,医师采纳。在治疗过程中,临床药师对患者使用芬太尼透皮贴剂提供用药教育并进行不良反应监测,发现芬太尼与仑伐替尼可能存在的药物相互作用。经过多次疼痛评估和会诊,患者疼痛控制较好,病情平稳出院。临床药师通过参与癌痛患者个体化方案的制定和全程管理,提高了患者用药的安全性和有效性。

A 47-year-old male patient with hepatic malignancy(postoperative)was admitted to hospital mainly due to ileus with severe pain.According to the WHO three-step analgesia principle,clinical pharmacists helped to select variety and dose of initial drugs for opioid-intolerant patients with cancer pain under the condition of depriving food and water,optimize the analgesic plan,and put forward proposal for controlling the breakout of cancer pain,which was adopted by physicians.During the course of treatment,clinical pharmacists provided medication education and monitoring of adverse drug reaction to him focusing on fentanyl transdermal,and concerned about the potential drug interacion between fentanyl and lenvatinib.After several pain assessments and consultations,the pain was well controlled and he was discharged.Clinical pharmacists improved the safety and effectiveness of medication by participating in the formulation and management of individualized programs for patients with cancer pain.