临床药师在静脉药物配置中心抗肿瘤药物合理应用中的作用(1)
摘 要 目的：对我院抗肿瘤药物静脉配置不合理医嘱情况进行调查分析，探讨临床药师促进合理应用抗肿瘤药物的作用。方法：提取我院静脉药物配置中心(PIVAS)经临床药师审核并建议修改的不合理抗肿瘤药物注射剂用药医嘱分类并统计，分析不合理用药原因，并就干预、改善不合理用药的对策进行总结。结果：发现不合理医嘱139组，占全部医嘱的0.36%，主要不合理为载体种类和载体量、给药剂量、顺序、时间和途径、配伍禁忌，以载体种类和载体量不合理最为常见。结论：我院临床药师通过多种对策，干预、改善抗肿瘤药物的不合理应用，为医师临床治疗决策提供帮助，协助医师合理设计化疗方案，提高药物治疗效果，规避不良反应的发生。
关键词 临床药师 抗肿瘤药物 不合理医嘱 合理用药 给药顺序
中图分类号：R979.1； R969.3 文献标识码：C 文章编号：1006-1533(2017)07-0065-07
Role of clinical pharmacists participating in rational use of antitumor drugs at PIVAS
WANG Chunhui*， WU Wei， LV Qianzhou**
(Department of Pharmacy， Zhongshan Hospital affiliated to Fudan University， Shanghai 200032， China)
ABSTRACT Objective： To investigate and analyze the irrational medical orders of antitumor medication at pharmacy intravenous admixture services (PIVAS) and explore the effect of clinical pharmacists on promoting rational use of antitumor drugs. Methods： The irrational medical orders of antitumor drugs for injection at PIVAS， which were checked and suggested to be modified by clinical pharmacists， were classified and counted and their reasons were analyzed. Meanwhile， the countermeasures for intervening and improving the irrational drug use were also summarized. Results： One hundred and thirty-nine sets of irrational medical orders (accounting for 0.36% of the total) were found and divided into seven fields such as solvent type and amount， drug dosage， administration sequence， time and route and incompatibility， in which the solvent type and amount were the most common. Conclusion： The irrational antitumor medications can be intervened and improved by clinical pharmacists through a variety of countermeasures so as to provide a help for the prescription of physicians， assist them to rationally design chemotherapy regimens， improve the clinical efficacy and avoid the occurrence of adverse drug reactions.
KEY WORDS clinical pharmacist； antitumor drug； irrational medical order； rational drug use； administration sequence
目前我國恶性肿瘤发病率呈快速上升趋势，抗肿瘤药物使用率也随之增加。传统的细胞毒性药物安全范围窄、作用机制和药代动力学复杂，临床用法、用量各异，联合用药普遍，严重不良反应多。近年来，尽管分子靶向药物的诞生，为临床综合治疗肿瘤提供了新的选择，但其不良反应依然不可忽视。因此建立静脉药物配置中心(pharmacy intravenous admixture service，PIVAS)来集中管理、审核、配置抗肿瘤药物医嘱对有效干预抗肿瘤药物的不合理使用、防范潜在的用药错误具有重要临床意义。
1 资料来源与方法
提取我院PIVAS 2014年1月—2015年12月抗肿瘤药物的用药医嘱及审核记录。依据药品说明书、《中华人民共和国药典临床用药须知(2010年版)》、《新编药物学》(第17版)、《临床静脉用药调配与使用指南》、《临床静脉用药调配方法与配伍禁忌速查手册》以及相关文献，对不合理用药医嘱进行分类统计，分析原因，并就干预、改善不合理用药的对策进行总结。
2 结果与分析
2.1 抗肿瘤药物不合理医嘱概况 (王春晖 吴薇 吕迁洲)
关键词 临床药师 抗肿瘤药物 不合理医嘱 合理用药 给药顺序
中图分类号：R979.1； R969.3 文献标识码：C 文章编号：1006-1533(2017)07-0065-07
Role of clinical pharmacists participating in rational use of antitumor drugs at PIVAS
WANG Chunhui*， WU Wei， LV Qianzhou**
(Department of Pharmacy， Zhongshan Hospital affiliated to Fudan University， Shanghai 200032， China)
ABSTRACT Objective： To investigate and analyze the irrational medical orders of antitumor medication at pharmacy intravenous admixture services (PIVAS) and explore the effect of clinical pharmacists on promoting rational use of antitumor drugs. Methods： The irrational medical orders of antitumor drugs for injection at PIVAS， which were checked and suggested to be modified by clinical pharmacists， were classified and counted and their reasons were analyzed. Meanwhile， the countermeasures for intervening and improving the irrational drug use were also summarized. Results： One hundred and thirty-nine sets of irrational medical orders (accounting for 0.36% of the total) were found and divided into seven fields such as solvent type and amount， drug dosage， administration sequence， time and route and incompatibility， in which the solvent type and amount were the most common. Conclusion： The irrational antitumor medications can be intervened and improved by clinical pharmacists through a variety of countermeasures so as to provide a help for the prescription of physicians， assist them to rationally design chemotherapy regimens， improve the clinical efficacy and avoid the occurrence of adverse drug reactions.
KEY WORDS clinical pharmacist； antitumor drug； irrational medical order； rational drug use； administration sequence
目前我國恶性肿瘤发病率呈快速上升趋势，抗肿瘤药物使用率也随之增加。传统的细胞毒性药物安全范围窄、作用机制和药代动力学复杂，临床用法、用量各异，联合用药普遍，严重不良反应多。近年来，尽管分子靶向药物的诞生，为临床综合治疗肿瘤提供了新的选择，但其不良反应依然不可忽视。因此建立静脉药物配置中心(pharmacy intravenous admixture service，PIVAS)来集中管理、审核、配置抗肿瘤药物医嘱对有效干预抗肿瘤药物的不合理使用、防范潜在的用药错误具有重要临床意义。
1 资料来源与方法
提取我院PIVAS 2014年1月—2015年12月抗肿瘤药物的用药医嘱及审核记录。依据药品说明书、《中华人民共和国药典临床用药须知(2010年版)》、《新编药物学》(第17版)、《临床静脉用药调配与使用指南》、《临床静脉用药调配方法与配伍禁忌速查手册》以及相关文献，对不合理用药医嘱进行分类统计，分析原因，并就干预、改善不合理用药的对策进行总结。
2 结果与分析
2.1 抗肿瘤药物不合理医嘱概况 (王春晖 吴薇 吕迁洲)