误行鞘内注射长春新碱事件病例报告的系统评价

Evaluation on case reports of inadvertent intrathecal vincristine administration

目的评价误行鞘内注射长春新碱事件的发生原因、患者神经损害的特点、抢救措施和预后。方法使用电子文献数据库、中英文纸质文献数据库和网络引擎三种方法检索误行鞘内注射长春新碱的病例报告,使用SPSS 15.0进行统计分析。结果最终纳入32例病例报告,分析显示鞘内注射长春新碱后患者结局不良,多数患者(25/32)结局为死亡,存活病例伴随下肢瘫痪或四肢瘫痪后遗症。患者临床进展过程表现为上行性脑脊髓病。早期识别错误并及时实施脑脊液脑室-腰椎脑脊液灌注引流术可以提高患者的生存概率。不同外科治疗措施组间、是否使用叶酸治疗组间、是否使用谷氨酸治疗组间和是否使用维生素B6组间的生存曲线差异有统计学意义。结论及时进行脑室-腰椎脑脊液灌注引流术、使用叶酸、谷氨酸对抢救患者生命十分重要,但难获得满意的临床转归,因此关键在于实施有效的预防措施。

Objective To evaluate the reasons for intrathecal administration of vincristine, the characteristics of patients with nerve damage, and the effective rescue measures and outcome prognosis. Methods Electronic literature databases, English and Chinese Paper Documents databases, and Network Engine were searched for Case Reports of inadvertent intrathecal injection of vincristine. SPSS 15.0 was used for statistical analysis. Results Analysis of 32 cases report showed that the intrathecal injection of vincristine in patients had adverse outcome. Of these cases 25 led to death, and survival of cases was associated with lower limb paralysis or quadriplegia. Fatalities appeared due to a progressively ascending myeloencephalopathy. Early recognition and immediate treatment with CSF drainage appeared to be the only intervention that had improved patients＇ survival. The survival curves of different surgical treatments, whether or not to use folic acid treatment, whether or not to use glutamate treatment, whether or not to use pyridoxinetreatment, was a significant difference. Conclusions Timely ventriculo-lumbar washout, using folic acid treatment and glutamate treatment appear critical. It is difficult to obtain satisfactory clinical outcome, so the key lies in the implementation of effective preventive measures.