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  [摘要] 目的 说明如何对老年合并高血压的乳腺癌患者进行药学监护及药学监护对患者的重要性。 方法 临床药师参与1例老年合并高血压的乳腺癌患者治疗过程，对患者进行药学监护，为临床提供合理化用药方案，即时处理用药后的不良反应。 结果 在临床药师的药学监护下，患者在围术期，抗菌使用合理，无切口感染；在化疗期，化疗药物安全使用，保证了手术和化疗的顺利进行。 结论 临床药师深入临床，参与药物治疗，不仅保证了临床用药的安全、有效，还为患者减轻了经济负担。

 [关键词] 乳腺癌；血压；药学监护；化疗

 [中图分类号] R737.31 [文献标识码] C [文章编号] 1673-7210(2012)02(c)-0103-02

 Pharmaceutical care of one patient with breast cancer during operation and chemotherapy

 ZHANG Pengfei

 Department of Pharmaceutical Affairs, Yangzhou Maternal and Child Care Service Center, Jiangsu Province, Yangzhou 225001, China

 [Abstract] Objective To explain how to implement pharmaceutical care for elder patients with breast cancer complicated by hypertension and the importance of pharmaceutical care to patients. Methods The clinical pharmacists participated in the treatment course of one elder patient with breast cancer complicated by hypertension, provided pharmaceutical care for the patient, provided rationalized drug administration schedule and timely managed post-administration adverse reactions. Results Under the pharmaceutical care of the clinical pharmacists, in the perioperative period, the patient received reasonable antibiosis and had no wound infection, and in the chemotherapy period, the chemotherapy drugs were safely used, which ensured the smooth progress of surgery and chemotherapy. Conclusion The clinical pharmacists deeply involved in the clinical drug treatment not only ensure the safety and effectiveness of clinical medication, but also reduce the financial burden for patients.

 [Key words] Breast cancer; Blood pressure; Pharmaceutical care; Chemotherapy

 乳腺癌是女性最常见的恶性肿瘤之一。在我国占全身各种恶性肿瘤的7%～10%，绝经后妇女的发病率最高[1]，而该年龄的妇女常常合并一些慢性病，在乳腺癌的手术治疗及术后化疗都存在一些特点。临床药师参与病区查房、讨论用药方案、指导临床医生合理用药是临床药师的日常工作之一。临床药师运用自己掌握的药学专业知识，对患者进行用药监护，为临床医生提供用药指导，提高了药物的治疗水平，减少了严重不良反应的发生。对本文报道了1例临床药师参与治疗1例合并有高血压的老年乳腺癌，从手术到第一次化疗的治疗过程，以期与广大临床药师一起探讨如何对乳腺癌患者开展药学监护。

 1 临床资料

 患者，女，60岁，体检发现左乳房有一肿块，约2 cm×1 cm，质硬，界不清，无触痛，形态不规则，表面不光滑。钼钯检查提示：左乳致密影。乳房B超提示：左乳多条状无回声区。根据以上的检查结果，临床初步诊断为左乳腺癌，分期考虑为T1N0M0～T2N0M0之间。因患者肿块距乳头、乳晕部较近，故不考虑保留乳房，以免局部易复发，而直接行“乳腺癌改良根治术”。患者有高血压史5年，现口服“硝苯地平200 mg，q 12 h”，血压130/86 mm Hg(1 mm Hg=0.133 kPa)。完善各项检查，无手术禁忌。入院后第3天，行“乳腺癌改良根治术”。术后第8天开始第1次化疗。

 2 临床药师会诊及用药监护情况

 2.1 围术期

 患者有高血压史，原用药“硝苯地平200 mg ......