合作药物治疗管理模式在癌痛规范化治疗中的应用

摘 要 目的：探索肿瘤科临床药师如何运用合作药物治疗模式（CDTM）参与癌性疼痛的治疗，更好地为临床癌痛治疗提供药学服务。 方法: 以2012年~2014年我院肿瘤科癌痛规范化示范病房创建实践为背景，收集癌痛规范化示范病房创建活动实施过程中需要进行止痛治疗的病例，临床药师加入疼痛治疗团队，运用CDTM药学服务模式，充分利用药品不良反应、代谢排泄途径、药物相互作用、禁忌证等相关知识，结合患者具体情况，以说明书及相关文献为循证依据，协助临床医师制定个体化给药方案；为患者提供全程药学监护以确保止痛药物的治疗效果。结果: 共收集癌痛病例126例，临床药师在CDTM模式下对其中123例进行了不同程度的用药干预，从调整滴定药物、选择维持药物、增减辅助用药、患者疼痛用药教育（心理干预）等多方面介入治疗环节；在此过程中临床药师提出的多项合理化建议为临床医生所接受，提高了止痛药物的治疗效果，降低或避免了药品不良反应。结论:CDTM药学服务模式明确了临床药师在药学服务各环节中的作用与责任，临床药师在癌痛患者治疗团队中利用自身熟悉药学知识及药物特点等优势，协助临床医师使癌痛患者的止痛治疗效果得到了提升，同时也使药师和医师的专业特长得到了充分发挥。

Application of Collaborative Drug Therapy Management in the Standard Treatment of Patients with Cancer Pain

ABSTRACT Objective: To explore the participation of clinical pharmacists in the standard treatment of patients with cancer pain by using collaborative drug therapy management (CDTM) in order to provide better pharmaceutical care for the patients with cancer pain. Methods:With the creation practice of demonstration ward of oncology department in our hospital from 2012 to 2014 as the background, the cases demanding for pain treatment were collected from oncology department during 2012 and 2014. Clinical pharmacists were involved in the pain treatment team under the frame of CDTM pharmaceutical service model and using the pharmaceutical knowledge including the characteristics of drug metabolism and excretion pathway, drug interactions, contraindication and adverse drug reactions, etc. Combined with the specific conditions of patients, medicine instructions and related documents as the evidence, clinical pharmacists assisted clinicians to develop individualized dosage regimen for the patients, and provided whole process pharmaceutical care to ensure the treatment effect of the patients.Results:Totallys 126 cases of cancer pain were collected in the study, among them, 123 ones received medicine therapy intervention in varying degrees under the CDTM mode, and clinical pharmacist involved in such therapy aspects as the adjustment of titration medicine, the choice of maintain drug, the addition or withdrawal of auxiliary medicines, the medicine education for the patients including psychological intervention and so on, and the rational proposals put forward by clinical pharmacists were all accepted by clinicians, which enhanced the analgesic drug treatment effect, reduced or avoided the adverse drug reactions. Conclusion:CDTM pharmaceutical service model defines the role and responsibilities of clinical pharmacists in each link of pharmaceutical service. In the treatment team for patients with cancer pain, clinical pharmacists assist clinicians to improve analgesic therapy effect in cancer patients by making use of their own advantages such as familiarity with knowledge of medicines and characteristics of drugs; meanwhile, pharmacist and physicians can bring their own specialties into full play.