Page 95 - 《中国药房》2021年23期

·药师与药学服务·

临床药师在吞咽障碍肿瘤患者口服用药中的药学服务 Δ

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赵秋玲 ，肖胜龙 ，张龙凤 ，陈 婷 ，杨 琳 （1.福建医科大学附属肿瘤医院/福建省肿瘤医院药剂科，福州
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350014；2.福建医科大学附属肿瘤医院/福建省肿瘤医院肿瘤内科，福州 350014）
中图分类号 R969.3；R73 文献标志码 A 文章编号 1001-0408（2021）23-2901-06
DOI 10.6039/j.issn.1001-0408.2021.23.15

摘 要 目的：探讨临床药师在吞咽障碍肿瘤患者口服用药中的药学服务方式，促进临床合理安全用药。方法：以典型案例为依
据，分析临床上吞咽障碍的肿瘤患者在口服用药过程中存在的问题，阐明临床药师给予的用药指导与药学监护。结果：临床药师
发现吞咽障碍肿瘤患者在口服用药时存在给药位置不当、缓控释制剂打开胶囊后管饲给药、给药途径受限、咬碎细胞毒性药物、靶
向药物的溶解性不明、多种药物联用时的相互作用等问题。针对上述问题，临床药师结合患者的疾病特点、药剂学、药动学、药效
学、药物溶解性、药物相互作用等因素，协助临床医师和护理人员向患者提供药学服务，如巧用适宜的给药位置和方式、采用局部
给药的方式、基于药剂学知识（新剂型特征）遴选适宜的剂型、熟悉细胞毒药物和靶向药物的特点以指导患者正确用药、重视潜在
的药物相互作用、指导护理人员正确给药等。患者用药不当的情况得以改善。结论：临床药师应积极参与临床治疗，利用自身药
学知识的优势进行药学干预，这有助于促进吞咽障碍肿瘤患者正确口服用药。
关键词 临床药师；吞咽障碍；肿瘤患者；口服用药；合理用药；药学服务

Pharmaceutical Care for Oral Medication of Tumor Patients with Dysphagia by Clinical Pharmacists
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ZHAO Qiuling ，XIAO Shenglong ，ZHANG Longfeng ，CHEN Ting ，YANG Lin（1. Dept. of Pharmacy，the
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Affiliated Cancer Hospital of Fujian Medical University/Fujian Cancer Hospital， Fuzhou 350014， China；
2. Dept. of Oncology，the Affiliated Cancer Hospital of Fujian Medical University/Fujian Cancer Hospital，
Fuzhou 350014，China）
ABSTRACT OBJECTIVE：To explore the mode of pharmaceutical care for oral medication of tumor patients with dysphagia by
clinical pharmacists，so as to promote clinical rational and safe drug use. METHODS：Based on typical cases，the problems existing
in the oral medication of tumor patients with dysphagia were analyzed，and the medication guidance and pharmaceutical care given
by clinical pharmacists were expounded. RESULTS：Clinical pharmacists found that tumor patients with dysphagia had some
problems during oral medication，such as improper administration position，tube feeding of slow-controlled release preparations
after opening the capsule，limited administration route，biting cytotoxic drugs，unknown solubility of targeted drugs，interaction of
multiple drugs. In view of the above problems，clinical pharmacists assisted physicians and nursing staff to provide pharmaceutical
care to patients in combination with the patient’s disease characteristics，pharmacy，pharmacokinetics，pharmacodynamics，drug
solubility，drug interaction and other factors，such as skillfully using appropriate drug delivery location and mode，using local drug
delivery mode，selecting appropriate dosage form based on pharmaceutical knowledge（the characteristics of new dosage form），
guiding patients to use drugs correctly by being familiar with the characteristics of cytotoxic drugs and targeted drugs，paying
attention to potential drug interactions and guiding nurses to use drugs correctly. The situation of improper medication was
improved. CONCLUSIONS：Clinical pharmacists should participate in clinical therapy actively，and make appropriate interventions
with professional knowledge of pharmacy so as to promote the correct use of oral medication for tumor patients with dysphagia.
KEYWORDS Clinical pharmacist；Dysphagia；Tumor patients；Oral drugs；Rational drug use；Pharmaceutical care

《中国吞咽障碍评估与治疗专家共识》指出，吞咽障
Δ 基金项目：福建省卫生计生科研人才培养项目（No.2018-ZQN-
18）；北京康盟慈善基金会医学科研发展基金项目（No.WS058C，No. 碍是指多种原因所致的口咽部及食管结构与功能异常，
yxky-TQ202101） 从而造成吞咽器官不能安全、有效地把食物等输送到胃
＊ 副 主 任 药 师 ，硕 士 。 研 究 方 向 ：肿 瘤 药 学 。 电 话 ：0591- [1]
内 。研究资料显示，约40％的65岁以上老年人存在吞
83660063转5305。E-mail：39419282@qq.com
[2]
咽障碍 。肿瘤患者常因疾病进展出现吞咽障碍。任佳
# 通信作者：副主任药师，硕士。研究方向：肿瘤药学。电话：
[3]
0591-83660063转8323。E-mail：apera@163.com 等 研究发现，头颈部肿瘤术后约 65％的患者会发生吞
中国药房 2021年第32卷第23期 China Pharmacy 2021 Vol. 32 No. 23 ·2901 ·