目的：探讨顺铂＋氟尿嘧啶联合治疗食管癌后出现Ⅳ度骨髓抑制的原因，以减少肿瘤患者化疗后出现骨髓抑制的风险，提高患者预后及生存时间。方法：针对1例典型病例，依据食管癌相关诊疗规范和指南进行分析，评价顺铂＋氟尿嘧啶治疗的方案是否合理、化疗药的剂量是否适宜、对患者化疗相关性不良反应的监护是否密切、对化疗相关性不良反应的处置是否及时、有效，以及化疗药与骨髓抑制的关系等。结果：经临床药师分析，该例患者使用顺铂＋氟尿嘧啶治疗的方案合理，但氟尿嘧啶剂量偏小；顺铂和氟尿嘧啶均有导致骨髓抑制的风险，医务人员没有严密监护患者化疗后相关血液学指标，在患者及家属要求出院时，没有明确患者的相关身体指标是否适合出院。结论：作为肿瘤科临床药师，应协助临床医师监护患者化疗过程的安全性。尤其是首次化疗的患者，应对其进行用药教育，告知可能的化疗风险，避免患者在出现不适症状时产生恐慌。如有异常，应及时提示临床医师进行干预，尽可能降低化疗风险。%OBJECTIVE:To probe into the causes of myelosuppression (Ⅳ degree ) in one case of esophageal cancer after treatment with cisplatin plus fluorouracil so as to reduce the risk of bone marrow in tumor patients after undergoing chemotherapy and improve tumor patients� prognosis and survival time. METHODS: Based on the related standard and guideline about the diagnosis and treatment of esophagus cancer, we evaluated whether the therapeutic regimen of cisplatin plus fluorouracil and the dosage of the chemotherapeutic drugs were rational, whether medical staff gave close attention to patients� chemotherapy⁃related adverse reactions, gave timely and effective management on the chemotherapy⁃related adverse drug reactions and the relation between chemotherapeutic drugs and myelosuppression. RESULTS:The therapeutic regimen cisplatin plus fluorouracil was rational but the dose of fluorouracil was on the lower side;both cisplatin and fluorouracil have the risk of causing bone marrow depression; medical staff did not pay close monitoring on patient�s chemotherapy⁃related hematological indices, nor did they define whether patient�s relative physical indicators are suitable for discharge when the patients and their family members had requirement for discharge from hospital. CONCLUSIONS:As a clinical pharmacist in the department of oncology, he should assist clinicians to monitor patients� safety throughout chemotherapy; for patients undergoing chemotherapy for the first time, clinical pharmacist provide them with medication education and let them know the potential risk of chemotherapy so as to avoid panic in case of adverse reactions. Furthermore, pharmacist should remind clinician to adopt intervention in case of abnormality so as to minimize the chemotherapy⁃related risks.
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