肺腺癌合并左肺阻塞性肺炎及左下肢深静脉血栓患者治疗药学监护

摘要

One case of middle-aged female patient was admitted to hospital due to left lung adenocarcinoma. Her admitting diagnosis were left lung adenocarcinoma, left lung obstructive pneumonia, left lower extremity deep vein thrombosis. Low molecular weight heparin and warfarin were successively given to the patient for lower limb venous thrombus. Clinical pharmacist evaluated the rationality of the overlapping time of the low molecular weight heparin and warfarin, and adjusted the dosage of warfarin according to INR values. Megestrol acetate dispersible tablets was withdrawn because it might contribute to the formation of deep vein thrombosis. Clinical pharmacists analyzed that developed and aggravated thrombosis might be resulted in the combining use of antibiotics, chemotherapeutic agents and warfarin, which was forwarded to doctors. Discharge education was offered to the patient, such as avoiding taking drugs and foods which can affect the blood concentration of warfarin, monitoring INR values and so on.%1例中年女性患者，因肺癌化疗入院，入院诊断为左肺腺癌（T4N3M0，Ⅲb期），左侧阻塞性肺炎，左下肢深静脉血栓。因患者出现下肢深静脉血栓，先后使用低分子肝素和华法林治疗，临床药师评估了低分子肝素和华法林的重叠使用时间，并通过动态测定INR调整华法林的用量。因甲地孕酮分散片（宜利治）可促进深静脉血栓形成，建议停用。同时，临床药师分析了血栓形成及加重可能是因左下肺阻塞性肺炎治疗所使用的抗生素及肺癌治疗应用的化疗药与华法林的相互作用所致，提示医生予以关注，并就可能影响华法林血药浓度的药物和食物以及INR监测等对患者进行出院教育。