临床药师对1例罕见的吉非替尼致肺腺癌患者肝损伤伴胆囊炎的用药分析(1)
摘 要 目的：探討临床药师在吉非替尼致肺腺癌患者肝损伤伴胆囊炎治疗过程中的作用，并为类似患者的治疗提供参考。方法：临床药师参与1例吉非替尼致肺腺癌患者肝损伤伴胆囊炎的治疗过程。该患者长期口服吉非替尼片进行抗肿瘤治疗，因转氨酶异常升高入院，医师给予静脉滴注硫普罗宁钠+乙酰半胱氨酸+还原型谷胱甘肽+胞磷胆碱进行保肝治疗，效果不佳。临床药师查阅文献并结合患者病情分析后建议停用吉非替尼，采取静脉滴注异甘草酸镁注射液0.2 g+5%葡萄糖注射液250 mL，qd进行单药保肝治疗;患者出院后口服吉非替尼片，再次因转氨酶异常升高入院，并伴非感染、非结石性胆囊炎，临床药师建议继续静脉滴注异甘草酸镁注射液0.2 g+5%葡萄糖注射液250 mL，qd进行保肝治疗，同时口服胆舒胶囊0.9 g，tid进行保守治疗，并密切监护患者相关指标的变化;于出院后嘱患者停用吉非替尼，口服盐酸埃克替尼片0.125 g，tid+复方红豆杉胶囊0.6 g，tid进行抗肿瘤治疗。结果：医师采纳临床药师的意见;患者转氨酶恢复正常水平，胆囊炎性症状基本消退。结论：在治疗吉非替尼致肺腺癌患者肝损伤伴胆囊炎过程中，临床药师协助医师完善了治疗方案，保障了其用药的有效性。
关键词 吉非替尼;肺腺癌;药物性肝损伤;胆囊炎;药学监护
中图分类号 R969.3;R734.2 文献标志码 A 文章编号 1001-0408(2020)20-2546-05
DOI 10.6039/j.issn.1001-0408.2020.20.20
ABSTRACT OBJECTIVE： To investigate the role of clinical pharmacists in the therapy of gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma， and to provide reference for the therapy of similar type of patients. METHODS： Clinical pharmacists participated in the treatment for gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma. The patient took Gefitinib tablets orally for a long time for anti-tumor treatment， and was hospitalized due to abnormal increase of transaminase. The doctors gave intravenous infusion of tiopronin sodium+ acetylcysteine+reduced glutathione+citicoline to protect liver， but the effect was not good. After consulting the literature and analyzing the patient’s condition， clinical pharmacists suggested that gefitinib should be stopped， and Magnesium isoglycyrrhizinate injection 0.2 g+5% Glucose injection 250 mL， ivgtt， qd for liver protection treatment. After discharge， the patient took Gefitinib tablets orally and was admitted to hospital again due to abnormal increase of transaminase， and suffered from non-infectious and non-calculous cholecystitis. Clinical pharmacists suggested continuing intravenous drip of Magnesium isoglycyrrhizinate injection 0.2 g+5% Glucose injection 250 mL， qd for liver protection treatment， oral administration of Danshu capsules 0.9 g， tid for conservative treatment; at the same time， closely monitoring the changes of related indicators. After discharge， clinical pharmacists instructed patients to stop gefitinib， and take Icotinib hydrochloride tablets 0.125 g， tid+Compound Taxus capsules 0.6 g， tid for anti-tumor treatment. RESULTS： The doctors adopted the opinions of clinical pharmacists， and the transaminase levels returned to normal， and the symptoms of cholecystitis basically subsided. CONCLUSIONS： In the treatment of gefitinib-caused liver injury complicated with cholecystitis in patients with lung adenocarcinoma， clinical pharmacists assisted doctors to improve the treatment plan and ensure the effectiveness of drug use., 百拇医药(廖玉芳 邹泽 岳建农)
关键词 吉非替尼;肺腺癌;药物性肝损伤;胆囊炎;药学监护
中图分类号 R969.3;R734.2 文献标志码 A 文章编号 1001-0408(2020)20-2546-05
DOI 10.6039/j.issn.1001-0408.2020.20.20
ABSTRACT OBJECTIVE： To investigate the role of clinical pharmacists in the therapy of gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma， and to provide reference for the therapy of similar type of patients. METHODS： Clinical pharmacists participated in the treatment for gefitinib-caused liver injury complicated with cholecystitis in a patient with lung adenocarcinoma. The patient took Gefitinib tablets orally for a long time for anti-tumor treatment， and was hospitalized due to abnormal increase of transaminase. The doctors gave intravenous infusion of tiopronin sodium+ acetylcysteine+reduced glutathione+citicoline to protect liver， but the effect was not good. After consulting the literature and analyzing the patient’s condition， clinical pharmacists suggested that gefitinib should be stopped， and Magnesium isoglycyrrhizinate injection 0.2 g+5% Glucose injection 250 mL， ivgtt， qd for liver protection treatment. After discharge， the patient took Gefitinib tablets orally and was admitted to hospital again due to abnormal increase of transaminase， and suffered from non-infectious and non-calculous cholecystitis. Clinical pharmacists suggested continuing intravenous drip of Magnesium isoglycyrrhizinate injection 0.2 g+5% Glucose injection 250 mL， qd for liver protection treatment， oral administration of Danshu capsules 0.9 g， tid for conservative treatment; at the same time， closely monitoring the changes of related indicators. After discharge， clinical pharmacists instructed patients to stop gefitinib， and take Icotinib hydrochloride tablets 0.125 g， tid+Compound Taxus capsules 0.6 g， tid for anti-tumor treatment. RESULTS： The doctors adopted the opinions of clinical pharmacists， and the transaminase levels returned to normal， and the symptoms of cholecystitis basically subsided. CONCLUSIONS： In the treatment of gefitinib-caused liver injury complicated with cholecystitis in patients with lung adenocarcinoma， clinical pharmacists assisted doctors to improve the treatment plan and ensure the effectiveness of drug use., 百拇医药(廖玉芳 邹泽 岳建农)