临床药师对2例异基因外周血干细胞移植患者的药学监护

目的：探讨临床药师在异基因外周血干细胞移植（allo-PBSCT）患者临床治疗中发挥的作用。方法：通过临床药师对2例allo-PBSCT患者实施药学监护，参与制订治疗方案，全程参与临床查房、病例讨论，对患者进行药学监护和用药教育。结果：A患者allo-PBSCT术后第11天，血常规提示造血重建；期间监测巨细胞病毒（HCMV-DNA）结果呈阴性；骨髓细胞学示骨髓增生明显活跃；患者生命征平稳，无发热等不适反应。B患者allo-PBSCT术后第11天，血常规提示造血重建。期间监测HCMV-DNA结果呈阴性；骨髓细胞学示粒系增生，红系增生低下；患者无发热、皮疹等移植物抗宿主病（GVHD）表现。结论：临床药师通过参与allo-PBSCT患者的药学监护，协同医师制订用药方案，可提高医师、护士和患者对临床药师的认可。减少药品不良反应，提高药物治疗效果，体现临床药师的价值。

Pharmaceutical Care for 2 Cases of allo-PBSCT by Clinical Pharmacist

OBJECTIVE： To study the role of clinical pharmacists in the treatment for patients with allogeneic peripheral blood stem cell transplantation （allo-PBSCT）. METHODS： Clinical pharmacists provided pharmaceutical care for 2 cases of allo-PBSCT, participated in the formulation of therapeutic plan, ward-round and case discussion, and carried out pharmaceutical care and medica- tion education. RESULTS： 11 days after allo-PBSCT, routine blood test of patient A reminded hematopoietic reconstruction; HC- MV-DNA was negative; bone marrow inspection showed active bone marrow hyperplasia; the vital signs of patients were stable without fever and other ADR. 11 days after allo-PBSCT, routine blood test of patient B reminded hematopoietic reconstruction; HC- MV-DNA was negative; bone marrow inspection showed myeloid cell hyperplasia and low erythroid cell hyperplasia; no fever, ery- thra and other GVHD manifestation were found. CONCLUSION： Through clinical pharmacists participate in pharmaceutical care for alIo-PBSCT patients, and collaborate with doctors on medical plan to improve the acceptance of doctors, nurses and patients for clinical pharmacists and realize the value of them.