1例食管癌伴癌痛患者合并躯体化的药学监护  

Pharmaceutical care on a patient with esophageal cancer and cancer pain combined with somatization

作　　者：徐思露 李婕[2] 朱家丽 吴楠[1] 黄凌莉 XU Si-lu;LI Jie;ZHU Jia-li;WU Nan;HUANG Ling-li(Department of Pharmacy,Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research/the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Pain Management,Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research/the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院药学部,江苏南京210009 [2]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院镇痛科,江苏南京210009

出　　处：《中国药物应用与监测》2022年第4期241-243,共3页Chinese Journal of Drug Application and Monitoring

基　　金：南京药学会-常州四药医院药学科研基金(2018YX008);江苏省肿瘤医院院内科研基金项目(ZM201922)。

摘　　要：1例52岁男性患者,主因“食管鳞癌伴颈部及前胸部疼痛半年”入院,初始镇痛方案为盐酸羟考酮缓释片联合吗啡镇痛泵滴定,后胃镜提示患者食管中下段肿胀合并出血,遂行胃管置入,由于盐酸羟考酮缓释片不能碾碎经鼻饲给药,临床药师建议调整镇痛方案为芬太尼透皮贴剂,并协助医师进行剂量换算。患者应用芬太尼透皮贴剂后多次出现剂量末期疼痛,临床药师建议缩短其给药间隔,医师采纳建议,患者前胸部疼痛明显减轻,但颈部疼痛仍未缓解。临床药师考虑患者情绪障碍明显,可能合并躯体化症状,医师提请心理科会诊,诊断患者为焦虑抑郁状态伴咽喉梗塞感与疼痛等躯体化症状,遂启动心理辅助治疗。后患者颈部及前胸部疼痛均缓解,生活质量得到改善。A 52-year-old male patient was admitted to hospital due to squamous cell esophageal cancer with neck and front chest pain for half a year.Oxycodone hydrochloride prolonged-release tablets combined with titration of morphine analgesic pump were given to him at first.And then the result of gastroscopy revealed swelling and bleeding in the lower and middle esophagus,so a gastric tube was placed.Since oxycodone hydrochloride prolonged-release tablets couldn't be crushed and injected through a nasal feeding tube,clinical pharmacists suggested switching to fentanyl transdermal patches and assisted physicians to complete dose conversion.However,the patient experienced end-of-dose pain several times after applying the fentanyl,and pharmacists suggested shortening the interval of fentanyl.Physicians adopted advice.After that,the patient's front chest pain significantly improved,but the neck pain remained as before.Clinical pharmacists considered that the patient had obvious mood disorder and might have somatization,and physicians asked the psychological department for consultation to diagnosed with anxiety and depression with somatization symptoms such as throat obstruction and pain.The psychological support treatment was conducted at once.Later,both the neck and front chest pain were relieved,and his quality of life was improved.

关 键 词：临床药师 癌痛 躯体化 剂量末期疼痛 

分 类 号：R969.3[医药卫生—药理学]