目的 探讨临床药师参与癌痛患者药物治疗的实践方法.方法 临床药师参与1例癌痛患者的镇痛治疗,患者使用盐酸羟考酮缓释片联合盐酸吗啡片进行剂量滴定,治疗中出现谵妄、嗜睡反应.药师分析了患者出现谵妄、嗜睡的可能原因,并建议医师合理地调整治疗方案.结果 临床药师的建议部分被采纳,经降低羟考酮缓释片剂量、将羟考酮更换成芬太尼透皮贴剂后患者谵妄、嗜睡逐渐消失,疼痛得到较好控制.结论 在临床实践中,尤其在面临少见的药物不良反应时,临床药师通过个体化药物治疗,有助于保证患者用药安全、有效.%Objective To discuss the pharmaceutical care protocol and methods for clinical pharmacists taking part in cancer pain management. Methods A patient developed delirium and drowsiness after using oxycodone hydrochloride prolonged-release tablet ( OXYCONTIN) and morphine hydrochloride tablet for pain titration treatment. The clinical pharmacist analyzed the reasons of delirium and drowsiness,and suggested a dose reduction of OXYCONTIN or converting OXYCONTIN to another opioid analgesic. Results The suggestion of the clinical pharmacist was partly accepted. After adjusting the treatment, the delirium and drowsiness disappeared gradually, and the pain was well controlled. Conclusion In clinical practice, especially when faced with a rare adverse drug reaction, clinical pharmacists are helpful for ensuring the safety and effectiveness in pain management, as well as improving the level of the treatment, by the implementation of individualized drug therapy.
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