郭益俊，王茹稼(1.南通市第一人民医院药剂科，江苏 南通　6000； .台州市中心医院药剂科，浙江 台州　318000)



临床药师参与1例老年前列腺癌合并高血压病及房颤患者的药学监护

郭益俊1*，王茹稼2(1.南通市第一人民医院药剂科，江苏 南通226000； 2.台州市中心医院药剂科，浙江 台州318000)

DOI10.14009/j.issn.1672-2124.2016.02.044

摘要目的：探讨药学监护在减少合并基础疾病的老年肿瘤患者化疗所致不良反应中的作用，为临床药师在此类患者中进行药学监护的切入点提供借鉴。方法：介绍临床药师参与1例老年前列腺癌合并高血压病及房颤患者的药学监护过程。结果：针对该患者的个体情况，临床药师分析了化疗药物可能带来的不良反应及其对老年人基础疾病的影响，配合医师为患者提供了合适的个体化辅助抗肿瘤和基础疾病治疗方案，并对相关药物进行了药学监护。结论：临床药师为该患者提供了合适的个体化辅助抗肿瘤和抗凝治疗方案，使患者避免了严重不良反应的发生，体现了临床药师在减少此类特殊人群化疗药物所致不良反应发生中的作用。

关键词前列腺癌； 化疗； 高血压； 房颤； 药学监护

Clinical Pharmacists’ Practice in Pharmaceutical Care for One Elderly Patient with Prostate Cancer Combined with Hypertension and Atrial Fibrillation

GUO Yijun1, WANG Rujia2(1.Dept.of Pharmacy, First People’s Hospital of Nantong, Jiangsu Nantong 226000, China; 2.Dept.of Pharmacy, Taizhou Central Hospital, Zhejiang Taizhou 318000, China)

ABSTRACTOBJECTIVE：To investigate the effects of pharmaceutical care in reducing the adverse reactions caused by chemotherapy in elderly patients with tumor and combined basic diseases, and to provide reference for the entry point of pharmaceutical care provided by the clinical pharmacists. METHODS: To introduce the process of clinical pharmacists’ practice in pharmaceutical care for one elderly patient with prostate cancer combined with hypertension and atrial fibrillation. RESULTS: According to the patient’s individual conditions, the clinical pharmacists analyzed the adverse reactions caused by chemotherapy drugs and the effects on the basic diseases in the elderly, and then assisted the clinicians to provide appropriate individual treatment schemes of adjuvant antitumor and the basic diseases for the patient. Pharmaceutical care was carried out on the related drugs. CONCLUSIONS: Clinical pharmacists provided appropriate individual adjuvant antitumor and anticoagulation therapy for the patient, which makes the patients away from the severe adverse reactions. It reflects that the clinical pharmacists’ significant role in reducing adverse reactions caused by chemotherapeutic drugs in such special crowd.

KEYWORDSProstate cancer; Chemotherapy; Hypertension; Atrial fibrillation; Pharmaceutical care

前列腺癌是泌尿外科老年男性患者常见的恶性肿瘤之一。随着人们生活质量的改善、寿命的延长，前列腺癌发病率有明显上升的趋势[1]。虽然绝大多数患者对内分泌治疗敏感，但几乎所有患者在治疗18个月后都会进展至激素抵抗性前列腺癌(hormone refractory prostate cancer，HRPC)，此类患者生存期一般不超过2年[2]。对于HRPC患者，标准的治疗是以多西他赛注射剂联合醋酸泼尼松龙片进行化疗。……