1例肺癌患者顺铂胸腔灌注化疗引起急性肾功能损伤的病例分析

One case of acute renal injury caused by pleural infusion of cisplatin chemotherapy in lung cancer patient

1例60岁女性肺癌患者,因肺癌心包腔转移入院治疗,既往有高血压、糖尿病史。入院时和进行胸腔灌注化疗前两次肾功能检查结果均提示正常,在进行胸腔灌注化疗3次(顺铂注射液90 mg+重组人血管内皮抑制素注射液30 mg)结束后的第2天和第5天复查肾功能结果均提示急性肾功能损伤。临床药师从患者的身体状况、原患疾病、药品不良反应、药物作用机制等方面分析引起急性肾功能损伤的原因,考虑顺铂引起的可能性较大,建议医生立即停用顺铂,给予患者补液(约3000 m L·d^(-1))治疗3 d,肾衰宁片(6片,tid)和金水宝胶囊(6粒,tid)辅助治疗12 d,治疗期间嘱患者多饮水以促进化疗药物的排出。经对症治疗,患者出院1周后来院复查肾功能结果提示各项指标均恢复到正常。

A 60-year-old female lung cancer patient with pericardial cavity metastasis was admitted to hospital. The patient had a history of high blood pressure and diabetes. The indicators of renal function were normal at the first day of admission and before cisplatin pleural infusion chemotherapy. The patient was treated with pleural infusion chemotherapy for 3 times（cisplatin 90 mg ＋ recombinant human endostatin injection 30 mg）, the results of renal function showed acute renal injury on the second day and the fifth day after cisplatin pleural infusion chemotherapy. Clinical pharmacists analyzed the possible reasons of acute renal injury from the patient＇s physical condition, original disease, adverse drug reaction, and mechanism of drug action. Clinical pharmacists considered that the reason was more likely due to the cisplatin, and suggested stopping cisplatin immediately. Rehydration therapy（about 3000 m L·d^-1） was given to the patient for 3 days, Shenshuaining tablets（6 tablets, tid） and Jinshuibao capsules（6 capsules, tid） for adjuvant treatment were given to the patient for 12 days. Clinical pharmacists told the patient to drink more water for promoting drug elimination. After symptomatic treatment, the results showed that the renal function restored to normal a week after discharged from hospital.