唐蒲菁 黄光辉

    [摘要] 探讨临床药师在肿瘤住院患者伴有疼痛及肝功能能不全治疗过程中的作用，通过参与1例胰腺癌合并肝功能不全患者的治疗过程，利用所学的专业知识和技能对患者出入院的全过程进行药学监护，及对临床医师进行用药指导，从而提高患者用药安全性，减少治疗过程中出现药物不良反应的风险，增加患者用药依从性。通过该患者的全程指导，临床药师建议肝功能不全的老年患者，若其属于重度疼痛，初始镇痛推荐口服美沙酮片剂。

    [关键词] 临床药师;胰腺癌;疼痛;肝功能不全

    [Abstract] To investigate the function of clinical pharmacists in the treatment of cancer in patients with pain and hepatic insufficiency， by the means of participating in the treatment of a patient with pancreatic cancer complicated with hepatic insufficiency， and using our professional knowledge and skills to carry out pharmaceutical nursing during the whole process of admission and hospitalization， as well as to giving medication guidance to clinicians. So as to improve the safety of patients' medication， reduce the risk of adverse drug reactions in the treatment process and increase the compliance of patients' medication. Through the whole-course guidance of the patient ......