1例肝胆管细胞癌患者伴发药物性重度骨髓抑制合并肺部感染的药学监护实践

目的：探讨临床药师对伴发肝损害、药物性重度骨髓抑制合并肺部感染的癌症患者实施药学监护的切入点。方法：临床药师通过参与1例肝胆管细胞癌患者应用GP方案（吉西他滨+顺铂）化学治疗后出现药物性重度骨髓抑制合并肺部感染的治疗，分析导致重度骨髓抑制的原因，协助医生合理选择药物并实施药学监护。结果：患者的骨髓抑制及感染症状缓解，体温恢复正常，无血小板减少性出血等其它药物不良反应事件发生。结论：GP方案易导致严重骨髓抑制，因此，在化疗前应重视风险评估，适时调整药物剂量，尽量避免或减少不良反应的发生。临床药师应注重个性化药学监护，保障患者用药安全合理。

Pharmacetutical Care Practice of One Intrahepatic Cholangiocarcinoma Patient with Severe Myelosuppression Complicated with Lung Infection

Objective: To discuss the starting point for clinical pharmacists to carry out pharmaceutical care of cancer patients with liver damage, and severe myelosuppression complicated with lung infection. Methods: The clinical pharmacists analyzed the causes of severe myelosuppression, helped physicians to select appropriate drugs, and performed the pharmaceutical care by participating in the treatment of a intrahepatic cholangiocarcinoma patient with severe myelosuppression complicated with lung infection after underdone GP chemotherapy regimen (gemcitabine plus cisplatin). Results: The myelosuppression and the infection symptoms of the patient were relieved and the temperature returned to normal. No other adverse drug reactions, such as thrombocytopenic bleeding were found. Conclusion: The GP regimen can induce severe myelosupression. Therefore, attention should be paid to risk assessment before chemotherapy, and drug doses should be appropriately adjusted to avoid or reduce the adverse drug reactions. Clinical pharmacists should pay attention to personalized pharmaceutical care to ensure safe and rational drug use on patients.