1例疑似中药引发药物性肝损伤化疗患者的药学监护

发布时间：2018-03-31 20:33

本文选题：中药　切入点：化疗　出处：《中国药房》2017年32期

【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60m L,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 in the treatment of drug-induced liver injury (Dili) patients.Methods: clinical pharmacists took part in the course of drug therapy in one patient with colon cancer. In view of the possible gastrointestinal reaction caused by chemotherapeutic drugs, tropisetron methoxyclopramide promethazine should be given to stop vomiting before chemotherapy.Before the second chemotherapy, DILI appeared in the patients. According to the history of drug use and the characteristics of drug action, the clinical pharmacists judged that DILI might be related to the traditional Chinese patent medicine (Guben Yichang tablet) and the prescription granules of traditional Chinese medicine which were taken during the two chemotherapies.It was suggested that the drugs such as polyenylphosphatidylcholine, reduced glutathione and compound glycyrrhizin should be stopped, and pharmacological monitoring such as efficacy evaluation, adverse reaction monitoring, medication education and telephone follow-up should be carried out at the same time.Results: the physician accepted the advice of the clinical pharmacist.The indexes of liver function returned to normal and three times of chemotherapy were successfully completed.Conclusion: when DILI appears in cancer patients during chemotherapy, clinical pharmacists should help doctors to find out and judge the drug factors that lead to DILI, and to make and adjust the drug use plan according to the history of drug use and the characteristics of drug action.Reduce the degree of drug-induced liver injury and ensure the smooth progress of chemotherapy.
【作者单位】：广州市花都区人民医院药学部;广州市花都区人民医院普通外科;
【分类号】：R575

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