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1例疑似中药引发药物性肝损伤化疗患者的药学监护
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| 篇名： | 1例疑似中药引发药物性肝损伤化疗患者的药学监护 |
| TITLE： | |
| 摘要： | 目的：探讨临床药师在药物性肝损伤（DILI）化疗患者药物治疗中的作用。方法：临床药师参与1例结肠癌患者的药物治疗过程，针对化疗药可能导致的胃肠道反应，建议于化疗前给予托烷司琼+甲氧氯普胺+异丙嗪止吐；患者在第2次化疗前出现了DILI，临床药师根据其用药史及药物作用特点，判断DILI可能与两次化疗期间所服用的中成药（固本益肠片）和中药配方颗粒有关，建议给予多烯磷脂酰胆碱注射液465 mg，ivgtt，qd+注射用还原型谷胱甘肽1 g，ivgtt，qd护肝，并加用复方甘草酸苷注射液60 mL，ivgtt，qd抗炎和调节免疫功能；待患者肝功能恢复正常后，建议停用多烯磷脂胆碱、还原型谷胱甘肽、复方甘草酸苷等药物；同时行疗效评价、不良反应监测、用药教育、电话随访等药学监护。结果：医师采纳临床药师建议。患者肝功能指标恢复正常，顺利完成3次化疗。结论：当肿瘤患者化疗期间出现DILI时，临床药师应结合其用药史及药物作用特点，协助医师查找和判断导致DILI的药物因素，并协助其制订和调整用药方案，降低药物性肝损伤的损害程度，保证化疗的顺利进行。 |
| ABSTRACT： | OBJECTIVE： To investigate the role of clinical pharmacists on drug therapy for a chemotherapy patient with drug-induced liver injury （DILI）. METHODS： Clinical pharmacists participated in the therapy for a patient with colorectal cancer and suggested that ondansetron+metoclopramide+promethazine were given before chemotherapy for stopping vomiting because chemotherapy drugs might lead to gastrointestinal reaction. The patient suffered from DILI before second chemotherapy. According to the history of drug use and the characteristics of drug effects， clinical pharmacists estimated that DILI may be related to Chinese patent medicine （Guben yichang tablets） and TCM formula granules taken during the two chemotherapy periods. Clinical pharmacists recommended Polyene phosphatidylcholine injection 465 mg， ivgtt， qd+Reduced glutathione for injection 1 g， ivgtt， qd for protecting liver tissue， and additionally recommended Compound glycyrrhizin injection 60 mL， ivgtt， qd for inhibiting inflammation and regulating immune function. After liver function of the patient had been recovered， it was suggested to stop polyene phosphatidylcholine， reduced glutathione and compound glycyrrhizin， etc. Pharmaceutical care was also provided， including efficacy evaluation， ADR monitoring， medication education， telephone follow-up， etc. RESULTS： The physicians adopted the suggestions of clinical pharmacists. The liver function indexes of the patient recovered to normal， and then completed chemotherapy smoothly for 3 times. CONCLUSIONS： When tumor patients suffer from DILI during chemotherapy， clinical pharmacists should help physicians find and judge the drug factors leading to DILI based on the history of drug use and the characteristics of drug effects， and assist physicians to formulate and adjust medication plan so as to relieve the degree of DILI and guarantee the smooth development of chemotherapy. |
| 期刊： | 2017年第28卷第32期 |
| 作者： | 王快，郭胜蓝，曹天生，黄丽敏，陈浩，罗崇彬 |
| AUTHORS： | WANG Kuai，GUO Shenglan，CAO Tiansheng，HUANG Limin，CHEN Hao，LUO Chongbin |
| 关键字： | 中药；化疗；药学监护；药物性肝损伤；临床药师 |
| KEYWORDS： | TCM； Chemotherapy； Pharmaceutical care； Drug-induced liver injury； Clinical pharmacists |
| 阅读数： | 466 次 |
| 本月下载数： | 3 次 |
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