临床药师参与1例癌痛患者经PCIA镇痛的临床实践  

Clinical practice of clinical pharmacists involved in PCIA in patient with cancer pain

作　　者：张露 程模 何霖 杨培洪 彭杨 皮桃英 ZHANG Lu;CHENG Mo;HE Lin;YANG Pei-hong;PENG Yang;PI Tao-ying(Deparment of Pharmacy,Chongqing Dianjiang People's Hospital,Dianjiang 480300,Chongqing)

机构地区：[1]重庆市垫江县人民医院药剂科,重庆垫江408300

出　　处：《中药与临床》2019年第5期36-39,共4页Pharmacy and Clinics of Chinese Materia Medica

摘　　要：目的:观察经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)用于晚期癌痛患者的治疗效果,探讨临床药师参与癌痛管理工作的模式。方法:临床药师参与1例晚期结肠癌患者疼痛的治疗过程。患者入院前口服羟考酮缓释片止痛,入院后因合并肠梗阻需禁食禁饮,调整为芬太尼透皮贴治疗,疼痛控制欠佳。通过查阅相关文献后,临床药师选择"第四阶梯"镇痛模式,采用PCIA的方式镇痛。使用舒芬太尼注射液初始100μg通过镇痛泵持续泵入并进行滴定,最终调整滴速为5μg/h,锁定时间15min,自控按压剂量5mL,24小时持续镇痛。出院时更换为芬太尼透皮贴止痛。结果:该晚期癌痛患者使用PCIA方式镇痛后,疼痛得到有效控制,未出现明显不良反应。结论:PCIA可持续有效控制晚期癌痛,更好的改善晚期癌症患者的生存质量。临床药师深入临床后,发挥药学专业优势,开展癌痛评估,根据阿片类药物的药效/药动学参数,制定个体化给药方案,观察药品不良反应,保障患者用药有效、安全。Objective:To observe the efficacy of patient controlled intravenous analgesia (PCIA) in the treatment of advance cancer pain,and to explore the model of clinical pharmacists’ participation in the management of cancer pain.Method:Clinical pharmacist participated in the analgesia of one patient with advanced colon cancer.The patient took oxycodone sustained-release tablets to relieve pain before admission.After admission,food and water was inhibited due to intestinal obstruction.Fentanyl transdermal patch was used to replace oxycodone sustained-release tablets for analgesia.The pain was poorly controlled.The clinical pharmacist chose the "fourth step" analgesia mode and PCIA was then adopted.100 μg sufentanil injection was used for continuous analgesia via intravenous pump for 24 hours with titration rate of 5 μg﹒h-1,locking time of 15min and PCA dose of 5mL.It was adjusted as fentanyl transdermal analgesia at discharge.Result:Pain was effectively controlled in the patient with advanced cancer after PCIA without obvious side effect.Conclusion:PCIA can effectively control cancer pain and improve the quality of life in patients with advanced cancer.If the clinical pharmacists play role in clinic,they can take advantage of the pharmacy profession to carry out cancer pain assessment.According to the pharmacodynamic/pharmacokinetic parameters of opioids,individualized drug delivery plans will be formulated to observe adverse drug reactions and ensure the effective and safe use of drugs.

关 键 词：临床药师 PCIA 舒芬太尼 癌痛 

分 类 号：R735.3[医药卫生—肿瘤]