1例大剂量甲氨蝶呤注射液引起严重不良反应的病例分析.pdfVIP

Case Analysis 案例分析 1例大剂量甲氨蝶呤注射液引起严重不良反应的病 例分析 兰艳，刘少华，卢振，宫丽，龙坤，司延斌* [摘要] 患者因中枢神经系统淋巴瘤采取大剂量甲氨蝶呤(MTX)结合利昔妥单抗、阿糖胞苷及地塞米松治疗后，出现了大剂量 甲氨蝶呤引起的急性肾功能不全及骨髓抑制严重不良反应。通过监测患者的MTX血药浓度、血肌酐值以及结合亚叶酸钙解 救、足够碱化及水化的治疗手段，患者肾功能指标及血象恢复正常。因此，为了将MTX 引起的严重不良反应程度降至最低， 建议临床在甲氨蝶呤化疗后积极早期监测患者的MTX血药浓度，规范亚叶酸钙解救时间，及时碱化及水化尿液直至MTX血药 浓度降至安全范围内(0.1 μmol/L) 。 [关键词] 大剂量甲氨蝶呤 急性肾功能不全 骨髓抑制 治疗方法 [中图分类号] R96 [文献标识码] A [文章编号] 1672-2809(2015)22-0037-04 y s M e e AIU句画. of Mectica1 Recont恒 aPatiaat w恤圃庐dωe :Mc6otnmate扭曲回ed Scmn Adva:回R翩翩m R LAN Yan, LIU Shao-hua, LU Zhen, GONG li, LONG Kun, SI Yan-bing* [Abs恤d] t A patient was given high-dose methotrexate (HDMTX)plus rituximab, cytarabine and dexamethasone for the treatment of central nervous system Lymphoma, and thereafter the patient showed HDMTX-induced acute renal dysfunction, as a consequence of prolonged elimination, myelosuppression was substantially emerged. By monitoring plasma MTX concentrations and serum creatinine, using conventional treatment approaches of alkalinization, hydration and leucovorin rescue, the renal function, platelet count and white blood cell count eventually returned to baseline in the patient. Therefore, in order to reduce the incidence of the HDMTX-induced severe adverse reaction, it is critical to monitor plasma MTX concentrations as early as possible, and administrate with leucovorin, alkalinization and hydration promptly until plasma MTX concentrations reduced to a safe range(0.1μmol/L). y w ] High-dose Methotrexate; Acute Renal Dysfunction; Myelosuppression; Treatment Approaches [IK.eyW时I 5] 1 病例报告 钙血症，转入ICU对症治疗。 患者，女，44 岁，汉族。主诉因语言不利、 视野模糊、右侧听力下降伴行动困难2 月余入院治 2 治疗经过 疗。入院诊断为“中枢神经系统淋巴瘤”。 5 月15 入I C U 第 1 天 ( 5 月 1 9 日) 血生化结果 B U N 日因患者病情较重，医生给予R-MAD方案化疗：