目前 ,我国临床药学服务正从临床药学向药学监护全面发展与转变 ,这是一次医院药学领域的革命与飞跃。随着临床用药数量和种类的剧增 ,临床用药日趋复杂 ,多种药物合用已是常见的现象。因此合理地使用药物 ,减少或降低药物的有害作用是保证患者疗效和用药安全的关键。Johnson[1 At present, clinical pharmacy services in our country are developing and changing from clinical pharmacy to pharmacy care in an all-round way. This is a revolution and leap in the field of hospital pharmacy. With the dramatic increase in the number and types of clinical medication, clinical drug use has become more and more complicated, and the combination of multiple drugs has become a common phenomenon. Therefore, the rational use of drugs to reduce or reduce the harmful effects of drugs is to ensure the efficacy of patients and the key to drug safety. Johnson [1