某三甲儿童医院甲氨蝶呤血药浓度监测及影响因素分析

Monitoring and Influencing Factors of Methotrexate Blood Concentration in a Grade Ⅲ Level A Hospital

目的:监测我院使用大剂量甲氨蝶呤治疗急性淋巴细胞白血病及淋巴瘤患儿的血药浓度,并对影响因素进行分析。方法:采用回顾性研究方法,收集我院2015年6月至2017年9月使用大剂量甲氨蝶呤治疗的急性淋巴细胞白血病及淋巴瘤患儿的血药浓度监测报告共121份,归纳整理分析结果,探讨其影响因素。结果:121例甲氨蝶呤血药浓度监测报告中,24 h血药浓度有16例(13. 22%)超过危急值,最高值达72. 36μmol/L; 48 h、72 h血药浓度均能够维持在安全范围内,无超过危急值情况。尿液碱化对甲氨蝶呤的24 h血药浓度影响显著(P<0. 01)。结论:我院应进一步规范甲氨蝶呤使用方法,注意碱化尿液,加强血药浓度监测,以确保患儿用药安全。

Objective:To monitor the blood concentration of children with acute lymphoblastic leukemia and lymphoma treated with high-dose methotrexate in our hospital,and to analyze the influencing factors.Methods:Retrospective statistical analysis method was adopted.A total of 121 blood concentration monitoring reports were collected from children with acute lymphocytic leukemia and lymphoma treated with high-dose methotrexate in our hospital from June 2015 to Sept.2017,the results of the analysis were summarized and the influencing factors were discussed.Results:Of the 121 cases of methotrexate blood concentration monitoring reports,16 cases(13.22%)with the 24 h blood concentration exceeded the critical value,the highest value reached 72.36μmol/L.The blood concentration at 48 h and 72 h can be maintained within the safe range without exceeding the critical value.Urine alkalization had a significant effect on the 24 h blood concentration of methotrexate(P<0.01).Conclusion:Our hospital should further standardize the use of methotrexate,pay attention to the urine alkalization,and strengthen the blood concentration monitoring to ensure the safety of children.