卡铂导致妇科肿瘤患者过敏反应27例分析

Analysis of 27 cases of carboplatin-associated hypersensitivity reactions in patients with gynecologic tumor

目的回顾性分析卡铂在妇科肿瘤患者中导致过敏反应的高危因素、临床特征及其处理方法。方法收集2015年1月至2016年12月在我院妇科肿瘤病房接受含有卡铂化疗方案治疗时发生过敏反应的27例患者的临床资料,分析其发生的危险因素、临床特征,并探讨处理方法。结果在此期间共有246例患者接受含卡铂的化疗方案治疗,有27例发生过敏反应,占11.0%。11例(40.7%)患者过敏反应发生在第8疗程。19例发生在疾病复发后第2次接受含卡铂方案治疗时。12例(44.4%)患者发生时间与上次卡铂治疗间隔15～21个月。出现过敏反应时卡铂的累积剂量为3 500～12 400 mg。发生过敏反应时间为3～40 min,40.7%发生在化疗开始的10 min内。16例发生了严重的过敏反应,11例出现轻度过敏反应。所有患者经过糖皮质激素等抗过敏对症治疗后好转。结论对于敏感复发再次或多次应用含卡铂方案治疗的妇科肿瘤患者,医护人员应警惕过敏的发生,在输注卡铂时应注意密切观察患者。卡铂过敏反应临床特征多样,一旦发现过敏反应,应立即停药,并积极治疗,患者预后较好。

Objective To retrospectively analyze the high risk factors,clinical features and treatment of carboplatin-associated hypersensitivity reactions in patients with gynecologic tumors. Methods The clinical data of 27 patients who were treated in gynecologic oncology ward of our hospital and experienced a carboplatin-associated hypersensitivity reaction from January 2015 to December 2016 were collected. The risk factors,clinical characteristics and treatment method of carboplatin-associated hypersensitivity reactions were studied. Results During the period,of the246 patients who received chemotherapy with carboplatin,27（11. 0%） experienced a carboplatin hypersensitivity reaction; 11 patients（40. 7%） suffered a carboplatin hypersensitivity reaction in the eighth course of treatment; 19 cases developed this toxicity during their second carboplatin treatment program for recurrent disease; twelve patients（44. 4%）had a time interval of 15 ～ 21 months from the last carboplatin treatment. The cumulative dose of carboplatin was 3 500～ 12 400 mg when carboplatin hypersensitivity reactions occurred. The onset time of the reaction was from 3 min to 40 min,and 40. 7% of the reactions occurred within 10 minutes of the beginning of chemotherapy. Sixteen patients developed severe symptoms and 11 patients had mild symptoms. All patients were successfully treated with glucocorticoid and epinephrine. Conclusion Doctors and nurses should pay attention to patients who have been extensively pretreated with carboplatin,because they may be allergic to carboplatin. The clinical features of carboplatin hypersensitivity reactions are highly variable. Once the reactions are found,carboplatin infusion should be stopped immediately and the patients should be treated with glucocorticoid or epinephrine,which will result in good prognosis.