紫杉醇引起肿瘤患者过敏反应的临床分析

Clinical analysis of anaphylaxis in chemotherapy of paclitaxel in cancer patients

目的分析肿瘤患者应用紫杉醇制剂出现过敏反应的原因,探讨临床可采取的防治处理措施。方法收集2017年杭州市肿瘤医院肿瘤病房收治的应用紫杉醇制剂进行化疗的肺癌患者资料,进行回顾性分析。共纳入223例患者,其中男性130例,女性93例。年龄43~71岁,平均(57.6±6.4)岁。中心型肺癌120例,周围型肺癌103例。病理类型:鳞癌124例,腺癌84例,鳞腺癌15例。患者均为首次应用紫杉醇制剂,均无过敏史。紫杉醇用药前按照厂家的药品说明书进行预处理(地塞米松+苯海拉明+西咪替丁)。紫杉醇用药方法:剂量135~175mg/m^2,静脉输注,化疗第1天给药;或者多西紫杉醇75 mg/m^2,静脉输注,化疗第1天给药,4周为1个疗程,均给药4~6个化疗疗程。整理病历资料,分析肿瘤患者应用紫杉醇制剂出现的过敏反应,探讨其发生的原因及临床防治措施。结果紫杉醇制剂化疗应用中发生过敏反应的主要原因是:输液器选择不当,紫杉醇用药欠规范,患者精神紧张,过敏体质。临床可采取的防治措施包括:充分评估患者,选择专用化疗输液器具,严格执行紫杉醇过敏反应防范措施;加强做好监护及急救物品的准备;发生过敏反应规范化处理;做好患者健康教育和心理护理。结论紫杉醇用药规范化能预防和减少过敏反应的发生,监护及规范化处理发生的过敏反应能提高紫杉醇化疗的安全性。

Objective To analyze the causes of the anaphylaxis of paclitaxel in the chemotherapy of cancer patients, and discuss the reasonable treatment measures that can be taken in clinic. Methods In 2017 in the cancer ward of Hang- zhou Tumor hospital, the data of lung cancer patients who were treated with paclitaxel were analyzed retrospectively, A total of 223 patients were included, including 130 males and 93 females. The age ranged from 43 to 71 years old, and the average was （57.6 ± 6.4） years old. There were 120 cases of central lung cancer and 103 cases of peripheral lung canc- er. The pathological types were squamous cell carcinoma in 124 cases, adenocarcinoma in 84 cases, and squamous cell carcinoma in 15 cases. All the patients were used with paclitaxel for the first time, without any history of allergy. Accord- ing to the manufacturer＇ s instructions, the drug pretreatment （ dexamethasone ＋ diphenhydramine ＋ cimetidine） was made before the treatment of Paclitaxel. Methods of paclitaxel administration： dosage 135 - 175 mg/m2 , intravenous infu- sion, at the first days of chemotherapy, or docetaxel 75 mg/m2 , intravenous infusion, at the first days of chemotherapy, 4 weeks for 1 course, and chemotherapy was for 4 - 6 courses. The data of medical records were collected, and the ana- phylaxis of paclitaxel preparations in chemotherapy of tumor patients was analyzed. The causes and preventive measures for clinical application were discussed. Results The main reasons for anaphylaxis in paclitaxel chemotherapy were： in- appropriate infusion set, lack of paclitaxel medication, mental stress and allergic constitution. Conclusion The stand- ardization of paclitaxel can prevent and reduce the occurrence of anaphylaxis. Monitoring and standardizing the allergic reaction can improve the safety of paclitaxel chemotherapy.