长春新碱静脉注射无外渗致皮肤组织溃疡的原因及对策研究

Causes and countermeasures of tissue ulcer on intravenous injection of vincristine without extravasation

目的:探讨长春新碱(vincristine,VCR)静脉注射无外渗导致皮肤组织出现红肿、溃疡的原因,并提出相应的诊治对策。方法:选择我科2015-01~2018-10收治的急性淋巴细胞白血病患儿34例,其中15例静脉推注VCR后无外渗但出现皮肤红肿及溃烂现象,分析相关原因。结果:通过培训规范操作、深静脉置管、硫酸镁湿敷、热敷等干预措施,15例患儿皮肤损伤得到有效控制,未影响抗肿瘤治疗,后期静脉推注VCR经合理诊疗和积极预防,再未出现皮肤红肿及溃疡。结论:VCR作为儿童常用化疗药物,因其只能静脉注射,使用过程中渗液及皮肤受损风险很高,极易造成化学性静脉炎和周围神经毒性,甚至引起组织溃疡,因此使用时应提高静脉输注操作技术水平,积极处置不良反应,尽可能避免皮肤组织出现炎性反应,帮助患儿顺利完成化疗。

Objective:To analyze the causes of tissue ulcer on intravenous injection of vincristine(VCR)fluid without extravasation,and to provide treatment countermeasures.Methods:Thirty-four children with acute lymphoblastic leukemia were admitted during January 2015 and October 2018.Among them,15 children had no extravasation after intravenous injection of VCR,but redness and ulceration of skin were happened.The reasons were analyzed.Results:Through training,standard operation,deep vein catheterization,magnesium sulfate wet compress,hot compress,physiotherapy,skin damage were effectively controlled,and anti-tumor treatment was not affected.Active prevention and treatment were given in intravenous injection of VCR,no problems such as skin redness and ulcers were occurred.Conclusion:VCR is commonly chemotherapeutic drugs in children.Because it can only be injected intravenously,the risk of bleeding and skin damage are very high.It is easy to cause chemical phlebitis and peripheral neurotoxicity,and even cause tissue ulcers.The predictiveness of intravenous infusion chemotherapy drugs should be improved,and adverse reactions should be reduced.As far as possible,the inflammatory reaction of skin tissue should be avoided,and the chemotherapy should be successfully completed.