临床药师参与癌痛伴肾功能不全患者止痛方案的实践与经验

目的 探讨临床药师在止痛治疗中的作用，促进镇痛药更加规范的使用。方法 临床药师通过参与癌痛伴肾功能不全患者止痛方案的制定，从药物的选择、给药剂量以及不良反应预计等方面，提出药学观点。结果 医师采用了临床药师的建议，首日使用盐酸吗啡片进行快速滴定，次日起使用羟考酮缓释片控制背景疼痛，小剂量盐酸吗啡片控制爆发痛，在疼痛控制稳定后，改用芬太尼贴剂以减轻肾功能损害。结论 临床药师参与到重度癌痛患者的治疗方案制定中，能提高患者用药安全性、合理性，提高临床治疗效果。

Practice and experience in the participant of the clinical pharmacist in the treatment of cancer pain with renal insufficiency

Objective To investigate the effect of clinical pharmacists in the analgesic therapysoas to improve the rational use of analgesic drugs. Methods Clinical pharmacists participated in the formulation of drug therapy plan for the patient of cancer pain with renal insufficiency in respects of drug selection, dosage and adverse reaction monitoring. Results Physicians accepted suggestions from clinical pharmacists.The first day, the morphine hydrochloride tablets were used for rapid titration. The next day doxycodone were used, adding the morphine hydrochloride tablets when required. After the pain was controlled stability, the transdermal fentanyl was used to alleviate the damage of kidney. Conclusion The clinical pharmacist could assist clinicians to adjust the therapeutic regimen of the cancer patients with severe pain and improve the level of clinical drug treatment.