从1例溃疡型胃癌患者上消化道出血探讨抗血管生成药物的安全应用.pdfVIP

中国药物应用与监测 2016 年10月第13卷第5 期 Chinese Journal of Drug Application and Monitoring, Vol.13, No.5, October 2016 从1 例溃疡型胃癌患者上消化道出血探讨抗血管生成药物的安全应用 1 2 3 （1.郑州大学附属郑州中心医院药学部，河南 郑州 450000 ；2. 赤峰市医院药剂科，内蒙古 赤峰 024000 ； 杨晓瑞 ，梁明杰 ，王伟兰 3. 解放军总医院药品供应中心，北京 100853 ） [摘要]　1例56 岁溃疡型胃癌男性患者，因确诊“胃腺癌腹膜后淋巴结转移多发肝转移1年6 个月余”入院。该患者既往行多 周期化疗，治疗进展后给予阿帕替尼850 mg，qd 治疗，并于化疗第1、7 日腹腔灌注贝伐珠单抗100 mg。第8 日患者发生上消 化道出血，总量约1000 mL，遂停用阿帕替尼，同时给予抑酸、止血及输血等对症治疗，患者病情好转。临床药师结合相关文 献，探讨抗血管生成药物在溃疡型胃癌患者中的用药风险，建议临床在应用抗血管生成药物时应充分考虑患者出血风险；对 于高出血风险患者应慎用抗血管生成药物，尤其慎用2 种或以上抗血管生成药物。 [关键词]　溃疡型胃癌；上消化道出血；抗血管生成药物；安全应用 [ 中图分类号]　R969.4　　 [ 文献标识码]　A　 [ 文章编号]　1672 – 8157(2016)05 – 0280 – 04 Discussion on security application of antiangiogenic agents from upper gastrointestinal bleeding in a patient with ulcer-gastric carcinoma 1 2 3 YANG Xiao-rui , LIANG Ming-jie , WANG Wei-lan (1. Pharmaceutical Department, Zhengzhou Central Hospital Affiliated Zhengzhou University, Zhengzhou 450000, China; 2. Pharmaceutical Department, Chifeng Municipal Hospital, Chifeng 024000, China; 3. Department of Pharmaceutical Care, PLA General Hospital, Beijing 100853, China) [ABSTRACT]　One 56-year-old male patient was hospitalized for gastric adenocarcinoma with liver and lymph node metastases for more than 1.5 years. The patient had received 16 periods of chemotherapy, observed as progressive disease (PD). After administration of apatinib (850 mg, qd) for a month, the patient developed stable disease (SD). For the current chemotherapy, apart st th th from apatinib, bevacizumab was peritoneal perfused at the 1 and 7 day to control malignant hydroperitoneum. However, on the 8 day, upper gastrointestinal hemorrhage appeared and the apatinib or bevacizumab treatment was stopped. Pati