芬太尼透皮贴剂致胸壁肌肉强直继发呼吸困难的药学监护

发布时间：2018-03-08 12:18

本文选题：阿片类药物　切入点：芬太尼透皮贴剂　出处：《中国药房》2017年02期 　论文类型：期刊论文

【摘要】：目的:探讨临床药师在芬太尼透皮贴剂致胸壁肌肉强直继发呼吸困难患者药物治疗中的作用。方法:临床药师参与1例晚期前列腺癌伴重度疼痛患者的药物治疗,通过分析其用药史,结合相关药物药理作用特点和不良反应,协助医师识别和分析芬太尼透皮贴剂致胸壁肌肉强直继发呼吸困难的风险,并根据其症状先后建议暂不停用芬太尼透皮贴剂,加用肌松药盐酸乙哌立松片50 mg,po,tid缓解肌肉强直,停用劳拉西泮片、氟哌啶醇片和盐酸苯海拉明片以减少诱发谵妄的药物因素。结果:医师采纳临床药师建议,患者胸壁肌肉强直和呼吸困难得到缓解,疼痛得到满意控制,于入院第12天带药出院。结论:芬太尼透皮贴剂使用过程中出现的肌肉强直继发呼吸困难易与呼吸中枢抑制混淆,临床药师和医师应及时识别并正确处理。
[Abstract]:Objective: to investigate the role of clinical pharmacists in the treatment of patients with dyspnea due to transdermal fentanyl transdermal patch. Methods: one patient with advanced prostate cancer with severe pain was treated by clinical pharmacists. By analyzing the history of drug use, combining the pharmacological characteristics and adverse reactions of related drugs, we can assist doctors to identify and analyze the risk of dyspnea secondary to intrathoracic muscle rigidity caused by fentanyl transdermal patch. According to the symptoms, it was suggested that fentanyl transdermal patch should not be stopped temporarily, and the muscle relaxant Eperisone hydrochloride 50 mg / kg potid should be added to relieve muscle rigidity, and lorazepam tablet should be stopped. Haloperidol tablets and diphenhydramine hydrochloride tablets were used to reduce the drug factors inducing delirium. Results: according to the clinical pharmacist's advice, the patient's chest wall muscle rigidity and dyspnea were relieved, and the pain was satisfactorily controlled. Conclusion: dyspnea secondary to myotonic dyspnea in the course of using fentanyl transdermal patch is easily confused with respiratory center inhibition. Clinical pharmacists and doctors should recognize and correctly handle it in time.
【作者单位】：重庆医科大学附属第一医院药学部;
【分类号】：R737.25

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