静脉化疗药物不良反应病例分析与防治监测

Analysis and prevention cure monitoring of intravenous chemotherapy for adverse drug reactions

目的 分析静脉化疗药物不良反应病例和防治监控,为临床治疗提供参考。方法 回顾性分析广茂名市人民医院在2013年12月~2015年9月收治的肿瘤患者287例,设计问卷调查表,记录患者年龄、疾病类型、化疗方案、不良反应、部位信息,分析不良反应影响因素。结果 静脉化疗中曾经出现过不良反应患者共287例,总化疗次数为918次,不良反应主要表现在胃肠道系统489次（53.3%）、血液系统320次（34.8%）、心脏系统96次（10.5%）、神经系统8次（0.9%）等。消化系统不良反应以恶心呕吐（188次,31.4%）、腹泻（126例,13.7%）为主要表现,共发生骨髓抑制302次,以血红蛋白、白细胞下降为主要表现。随着年龄的增加,Ⅲ~Ⅳ度及患者不良反应发生率显著提高,50~70岁人群发生率最高,70岁以后有所下降。单一用药毒性小,联合用药化疗方案不良反应发生率较高,TP方案（紫杉醇与顺铂）与FOLFOX方案（奥沙利铂＋5-氟尿嘧啶＋CF）消化道不良反应发生率显著高于GP方案（吉西他滨＋顺铂）,TP方案骨髓抑制发生率显著高于FOLFOX方案和GP方案（P〈0.05）。铂类药物消化道不良反应较严重,紫杉类药物骨髓抑制比较严重,不同药物不良反应发生率存在一定差异。结论 静脉化疗不良反应发生率较高,一般为剂量限制性毒性,在化疗中应开展个体化用药方案,尽量将毒性不重叠的药物联合使用,提前采取预防措施,减少毒性反应。

Objective To study the analysis and prevention cure monitoring of intravenous chemotherapy for adverse drug reactions, and provide reference for clinical treatment. Methods 287 cases tumor patients in Maoming City People＇s Hospital from December 2013 to September 2015 were selected, questionnaire designed, age, type of disease,chemotherapy, adverse reactions, the site of infection and other information were recorded, adverse reaction factors were analyzed. Results There had been adverse reactions in intravenous chemotherapy patients with a total of 287 people,the total number 918 times of chemotherapy, adverse reactions mainly in the gastrointestinal system 489 times（53.3%）,blood system 320 times（34.8%）, heart of the system 96 times（10.5 %）, nervous system 8 times（0.9%） and so on. Digestive system adverse reactions nausea and vomiting（188, 31.4%）, diarrhea（126, 13.7%） were as the main performance. With increasing age. Ⅲ-Ⅳ and incidence of adverse reactions in patients were significantly increased, up to 50 to 70 year-olds had highest incidence rate, and decreased after 70 years. Single drug had lower toxicity, incidence of adverse reactions of combination chemotherapy was higher, incidence of adverse events of TP programs and FOLFOX regimen of gastrointestinal was significantly higher than that of the GP, incidence of bone marrow suppression of TP program was significantly higher than that of FOLFOX regimen and GP programs（P 0.05）. Platinum drugs gastrointestinal side effects were more serious, taxanes had more serious bone marrow suppression, there were some differences in the incidence of adverse drug reactions. Conclusion Intravenous chemotherapy adverse reaction rate is higher, is generally dose limit toxicity, should carry out individualized dosage regimen in chemotherapy without overlapping toxicity drugs used in combination as far as possible, take preventive measures in advance, and reduce toxicity.