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静脉输注甲氨蝶呤致严重急性神经系统损害一例并文献复习 被引量:2

Severe acute neurotoxicity following intravenous infusion of methotrexate: a case report and literature review
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摘要 目的 探讨静脉输注甲氨蝶呤(MTX)后引起严重急性神经系统损害的机制及救治措施.方法 报道1例42岁男性鼻型NK/T细胞非霍奇金淋巴瘤患者,接受第4次化疗、经外周静脉泵入MTX 1.1 g时(11h)出现尿潴留、感觉减退和肌力下降.为明确原因,更好地救治患者,在静脉输注MTX后22~143 h内的6个时间点,同时监测脑脊液及外周血MFX的药物浓度,并记录脑脊液常规及神经系统表现的变化情况.给予亚叶酸钙解救、大剂量甲泼尼龙冲击、丙种球蛋白输注、脑脊液置换及水化、碱化尿液等积极治疗措施.结果 6个时间点上,患者外周血与脑脊液中的MTX浓度基本一致,呈快速下降的趋势,但神经系统的损害逐渐加重,感觉受损平面逐渐上升至胸椎(T)1水平,直至不能行走、构音障碍、饮水呛咳、嗜睡和呼吸困难.经积极治疗,在用药98h后血药浓度降低至0.1 μmol/L,患者深、浅感觉及前臂肌力略有恢复,但其他症状无明显好转.2个月后因重症感染于重症监护室内死亡.结论 静脉输注常规剂量的MTX也可能引起急性严重神经系统损害,危及生命.该病可能与血脑屏障广泛受损等相关,具体机制不明.目前尚缺乏有效治疗方法,需要引起重视.
出处 《白血病.淋巴瘤》 CAS 2016年第5期305-308,共4页 Journal of Leukemia & Lymphoma
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参考文献17

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