石蕊+王保信++李立++卢丹丹

[摘要] 临床药师积极参与1例中晚期肺腺癌并颈部淋巴结转移高龄患者的治疗。根据患者病理诊断结果、功能状态评分及心、肝、肾功能评估，参与制订的化疗方案为培美曲塞（第1天，500 mg/m2）+顺铂（第1～3天，25 mg/m2）。患者于化疗第3天出现腹泻以及白细胞报危急值伴发热，第7天出现急性肾功能衰竭，第8～10天血小板报危急值。临床药师协助医师在抗菌药物选择、不良反应应对上提供药物治疗措施，将不良反应的危害降到最低。本文首次报道该化疗方案在治疗短时间内发生急性肾衰竭合并Ⅳ度骨髓抑制的严重不良反应。临床药师应在工作中參与制订肿瘤患者的治疗方案，并规范临床医师对化疗药物及其辅助用药的使用，减少因用药不规范产生的不良反应。

[关键词] 不良反应；培美曲塞；顺铂；肺癌；急性肾功能衰竭；Ⅳ度骨髓抑制

[中图分类号] R734.2；R692.3 [文献标识码] A [文章编号] 1673-7210（2017）01（b）-0170-05

Analysis on the adverse drug reactions and pharmaceutical care for one case of lung cancer patient with acute kidney failure and Ⅳ degree bone marrow depression caused by Pemetrexed plus Cisplatin

SHI Rui1 WANG Baoxin2 LI Li1 LU Dandan1 PAN Dan1 ZOU Qinghua2 ZHAO Kexin1

1.Department of Pharmacy， China National Petroleum Corporation Central Hospital， Hebei Province， Langfang 065000， China； 2.Department of Tumor， China National Petroleum Corporation Central Hospital， Hebei Province， Langfang 065000， China

[Abstract] Clinical pharmacists carried on the treatment for an elderly patient with advanced lung adenocarcinoma and developed in lymph node of neck. According to the results of pathologic diagnosis， performance status scores， function of cardiac， hepatic and kidney， the assigned chemotherapy plan was Pemetrexed （500 mg/m2， d1） + Cisplatin （25 mg/m2， d2-4）. The diarrhea and critical value of white blood count combined with fever， acute kidney failure and the critical value of platelet happened respectively at the third， seventh day and eighth to tenth day after chemotherapy. Clinical pharmacists assisted on choosing the antimicrobial agents for preventing infection and dealing with the adverse drug reactions， so as to decrease the danger of adverse reactions to the lowest. It is the first time to report that this chemotherapy can lead to acute kidney failure and Ⅳ degree bone marrow depression in 1 cure cycle. Making the treatment strategy for tumor patients and using regularly of chemotherapeutic drugs should be included in the clinical pharmacists' working plan， which will be helpful to reduce the adverse drug reactions caused by the haphazard drug treatment.

[Key words] Adverse drug reactions； Pemetrexed； Cisplatin； Lung cancer； Acute kidney failure； Ⅳ degree bone marrow depression

自1985年起，肺癌已成为全世界最常见的恶性肿瘤，在恶性肿瘤相关死亡原因中占第1位[1]。大约2/3的晚期非小细胞肺癌患者在诊断时已处于晚期（Ⅲb～Ⅳ期），失去手术机会，治疗手段以全身化疗为主[2]。多项临床报道显示培美曲塞联合顺铂治疗晚期非小细胞肺癌效果确切，且已成为一种应用较成熟的化疗方案[3-5]。美国FDA已将培美曲塞作为治疗晚期非小细胞肺癌的一线标准药物[6]。该化疗方案常见的不良反应为骨髓抑制和胃肠道不良反应，其次还包括肝损伤、乏力和皮疹等。本文临床药师结合临床实践，首次报道1例培美曲塞联合顺铂化疗1个周期后即出现急性肾衰竭合并Ⅳ度骨髓抑制严重不良反应案例，以期为临床治疗和合理用药提供参考。……