目的 临床药师通过对1例国内外罕见报道的卵巢癌术后复发伴淋巴结核血透患者的抗结核和化疗方案进行药学干预,达到了较好的治疗效果。方法 临床药师在血液透析患者化疗与抗结核治疗的复杂情况下,利用自己药学专业知识,查阅国内外相关资料,确定患者的抗结核及化疗方案,优化卡铂剂量,并对患者进行游离铂的浓度测定及不良反应等药学监护,计算AUC,优化下一次给药方案。结果 全院会诊建议患者先进行抗结核治疗,待淋巴结结核有所控制后再进行卵巢癌化疗。临床药师在医师会诊讨论基础上优化治疗方案为:利福平0.45 g,1日1次,晨空腹服;异烟肼,0.3 g,1日1次,透析当日在透析后给药;乙胺丁醇0.75 g,每周一、三、五透析后给药;根据Calvert公式计算卡铂0.15 g,并予以紫杉醇0.15 g·m-2化疗。给药结束24 h后进行血液透析,血液透析维持3 h,游离铂的浓度测定,化疗第2~4疗程方案为紫杉醇0.15 g·m-2,卡铂0.166 g,给药方式同第一疗程。在整个化疗过程中,患者无明显不良反应,抗结核治疗和化疗均取得较好疗效,且患者耐受性良好。结论 临床药师根据药物的药动学和药效学特点,结合患者病理生理情况,为患者设计最佳治疗方案、预防不良反应、监测治疗效果,使患者获得最佳治疗。
Abstract
OBJECTIVE To carry out pharmaceutical intervention on a complicated patient with oophoroma, lymphatic tuberculosis and regular hemodialysis to achieve better therapeutic effect.METHODS Clinical pharmacists developed anti-tuberculosis and anti-tumor schemes, optimized carboplatin dosage, determined free platinum concentrations, calculated AUC of platinum and monitored adverse drug effect by using their pharmaceutical expertise.RESULTS Hospital-wide consultation recommended this patient with prior anti-TB treatment, and continue with ovarian cancer chemotherapy after somewhat lymphatic tuberculosis is controlled. The final anti-TB treatment scheme is rifampicin 0.45 g, once daily, morning empty stomach; isoniazid, 0.3 g, once daily, administrated after dialysis on dialysis day; ethambutol, 0.75 g, administrated after each dialysis. The first course of anti-tumor schemes is paclitaxel 0.15 g穖-2 and carboplatin 0.15 g calculated according to Calvert formula, dialysis was carried 24 h later and kept 3 h. Then determined free platinum concentrations, and calculated out the following 2nd-4th courses of anti-tumor treatment, which is paclitaxel 0.15 g穖-2 and carboplatin 0.166 g. The patient had no significant adverse reactions throughout the course of therapy, and anti-tuberculosis and anti-tumor treatment achieved good effect and well tolerance by patients.CONCLUSIONS According to pharmacokinetic and pharmacodynamic characteristics of the drug combined with patient pathophysiological conditions, clinical pharmacist designs the best treatment schemes for patients, prevents adverse reactions and held treatment monitoring.This patient can get the best treatment as a result.
关键词
临床药师 /
抗结核治疗 /
卵巢癌化疗 /
血液透析 /
药学干预
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Key words
clinical pharmacist /
anti-tuberculosis /
anti-ovarian cancer chemotherapy /
hemodialysis /
pharmaceutical intervention
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中图分类号：
R969.3
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参考文献
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