CAJ | 학술논문

目的：分析1例大剂量吗啡致肠梗阻患者的用药情况，探讨临床药师在癌痛药物使用过程中的作用。方法：协同医师采用NRS评分动态评估患者疼痛情况，根据NRS评分进行剂量滴定、药物的选择、剂量转换。对大剂量吗啡致患者肠梗阻进行用药监护。结果：药学监护改善了患者用药依从性，转换为芬太尼贴后，患者肠梗阻缓解，并使本例对吗啡耐药患者的重度疼痛得到控制，改善了生活质量。结论：临床药师用药监护在癌痛规范化治疗过程中促进了本例肠梗阻患者阿片类药物合理使用，通过本例癌痛伴肠梗阻患者的成功治疗为同类难治性疼痛患者的阿片类药物规范使用提供参考。
목적：분석1례대제량마배치장경조환자적용약정황，탐토림상약사재암통약물사용과정중적작용。방법：협동의사채용NRS평분동태평고환자동통정황，근거NRS평분진행제량적정、약물적선택、제량전환。대대제량마배치환자장경조진행용약감호。결과：약학감호개선료환자용약의종성，전환위분태니첩후，환자장경조완해，병사본례대마배내약환자적중도동통득도공제，개선료생활질량。결론：림상약사용약감호재암통규범화치료과정중촉진료본례장경조환자아편류약물합리사용，통과본례암통반장경조환자적성공치료위동류난치성동통환자적아편류약물규범사용제공삼고。
Objective:To analyze the drug use of a patient with intestinal obstruction induced by high dose of morphine to explore the role of clinical pharmacists during the therapeutic process. Methods:The dose titration of morphine, choice of analgesic drugs and dose conversion were adjusted by doctors and pharmacists using NRS scores of dynamic assessment for the patient. The pharmaceutical care was implemented for the patient induced by high dose of morphine. Results:The pharmaceutical supervision by clinical pharma-cists improved medication compliance of the patient. After fentanyl patches were used to replace morphine, the intestinal obstruction was relieved in the patient and the quality of life was improved. Conclusion:Clinical pharmacist can promote the rational use of opi-oids for patients with intestinal obstruction. The successful treatment of the patient with intestinal obstruction provides the reference for patients with intractable pain treated by opioids.