中国药物警戒 ›› 2023, Vol. 20 ›› Issue (10): 1168-1172.
DOI: 10.19803/j.1672-8629.20230200

• 安全与合理用药 • 上一篇    下一篇

1例恶性肿瘤患者抗感染与抗肿瘤治疗的平衡抉择及药学监护

王燕婷1, 张媛媛2, 陈怡然2, 孙捷2, 朱宇3, 杨荔艳3, 吴知桂1,4, 申丽君1,5, 程敏2#, 李国辉1,*   

  1. 1国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院药剂科,北京 100021;
    2国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院妇瘤科,北京 100021;
    3国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院检验科,北京 100021;
    4西南医科大学附属医院药学部,四川 泸州 646000;
    5西南医科大学附属中医医院静脉用药调配中心,四川 泸州 646000
  • 收稿日期:2023-04-10 出版日期:2023-10-15 发布日期:2023-10-16
  • 通讯作者: *李国辉,女,本科,主任药师,医院药学。E-mail: lgh0603@126.com。 #为共同通信作者。
  • 作者简介:王燕婷,女,博士,副主任药师,肿瘤临床药学。
  • 基金资助:
    国家自然科学基金资助项目（82173333）; 中国医学科学院医学与健康科技创新工程项目（2021-I2M-C&T-B-056）

Balanced decision between anti-infective and antitumor therapies and pharmaceutical care for a malignant tumor patient

WANG Yanting1, ZHANG Yuanyuan2, CHEN Yiran2, SUN Jie2, ZHU Yu3, YANG Liyan3, WU Zhigui1,4, SHEN Lijun1,5, CHENG Min2,#, LI Guohui1,*   

  1. 1Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
    2Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
    3Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
    4Department of Pharmacy, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan 646000, China;
    5Pharmacy Intravenous Admixture Services, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan 646000, China
  • Received:2023-04-10 Online:2023-10-15 Published:2023-10-16

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摘要： 目的 探讨医生与临床药师共同对恶性肿瘤患者抗感染治疗与抗肿瘤治疗平衡抉择与药学监护的关键点。方法 报道临床药师全程参与1例晚期卵巢癌患者的治疗,主要针对感染性发热与肿瘤性发热的鉴别、抗感染药物选择、抗肿瘤治疗的药学监护等方面优化治疗。结果 在感染性发热与肿瘤性发热的鉴别诊断方面,不同医务人员之间存在较大分歧。经多学科综合权衡后决定优先进行抗肿瘤治疗,临床药师在感染的辅助诊断、抗肿瘤治疗的风险分析以及抗肿瘤治疗的药学监护等方面提供专业技术服务,促进患者用药安全。结论 对于感染相关指标高、感染诊断有分歧并经抗感染治疗无效的发热晚期肿瘤患者,可进行抗肿瘤治疗,但需平衡风险与获益并进行密切监护,临床药师与医生各自发挥专业优势,有助于提升患者用药的安全性和有效性。

关键词: 感染性发热, 肿瘤性发热, 卵巢癌, 抗感染, 化疗, 药学监护

Abstract: Objective To explore the balance between the anti-infective therapy and anti-tumor therapy and pharmaceutical care delivered to a malignant tumor patient by doctors and clinical pharmacists. Methods The roles of clinical pharmacists in the treatment of a case of advanced ovarian cancer were reported. Optimization of treatment focused on the differentiation of infectious fever from neoplastic fever, the selection of anti-microbial drugs, and the pharmaceutical care related to the anti-tumor therapy. Results Clinicians and pharmacists differed considerably in the differential diagnosis of infection and tumor fever for this patient. After multidisciplinary weighing, the anti-tumor therapy was selected and given with priority. Clinical pharmacists gave advice about the diagnosis of infection, risk analysis of the anti-tumor therapy and pharmaceutical care for the anti-tumor therapy so as to ensure the safety and efficacy of the treatment. Conclusion For patients diagnosed with advanced malignant tumor with high infection-related indicators but different diagnosis of infections, the anti-tumor therapy can be the first option, but the risks and benefits should be weighed and the patient should be monitored closely. Clinical pharmacists and doctors can help improve the safety and efficacy of pharmacotherapy by giving full play to their expertise.

Key words: infectious fever, tumor fever, ovarian cancer, anti-infection, chemotherapy, pharmaceutical care

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