临床药师参与一例肝细胞癌患者瑞格非尼治疗的药学实践-东南大学学报医学版

临床药师参与一例肝细胞癌患者瑞格非尼治疗的药学实践

单位：1. 江苏省肿瘤医院 & 江苏省肿瘤防治研究所 & 南京医科大学附属肿瘤医院药学部, 江苏南京 210009;
2. 中国药科大学基础医学与临床药学学院, 江苏南京 211198

分类号：R735.7;R730.53

出版年·卷·期（页码）：2020·39·第一期（62-65）

摘要：

目的：探讨临床药师在肝细胞癌患者抗肿瘤治疗中的作用。方法：1例肝细胞癌患者索拉非尼治疗进展后，临床药师通过查阅国内外的指南及文献，建议医生选用瑞格非尼靶向抗肿瘤，并参与患者瑞格非尼治疗的药学实践。结果：临床药师协助医生制定瑞格非尼个体化治疗方案，向患者提供用药指导及药学监护。治疗期间临床药师密切监测患者肝功能，出现药物不良反应后积极分析并提出建议，协助医生及时调整治疗方案，建议减少瑞格非尼服药剂量至120 mg每天1次的同时，使用异甘草酸镁注射液0.2 g每天1次对患者进行保肝治疗，及时干预瑞格非尼导致的药物性肝损伤，保证用药的安全有效。结论：临床药师在抗肿瘤治疗中发挥了促进合理用药的重要作用。

Objective: To explore the role of clinical pharmacists in anti-tumor therapy for patients with hepatocellular carcinoma. Methods: After the progress of treatment with sorafenib in a case of hepatocellular carcinoma patient, the clinical pharmacists recommended clinicians choosing regorafenib for targeted anti-tumor therapy through consulting domestic and foreign guidelines and literatures, and participated in pharmaceutical practice treated with regorafenib. Results: The clinical pharmacists assisted clinicians in developing individualized treatment plans for regorafenib, provided the patient with medication guidance and pharmaceutical care.During the treatment, the clinical pharmacists closely monitored the liver function of the patient, analyzed actively and made recommendations to assist clinicians to adjust the treatment plan in time after the appearance of adverse reactions. It was recommended to reduce the dose of regorafenib to 120 mg qd and use magnesium isoglycyrrhizinate injection 0.2 g qd for hepatoprotective treatment, clinical pharmacists promptly intervened in the drug-induced liver injury caused by regorafenib, ensured the safety and effectiveness of medication. Conclusion: Clinical pharmacists play an important role in promoting rational drug use in anti-tumor therapy.

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