顺铂过量致毒性反应的临床救治的文献分析

Literature Case Analysis on Toxicities and Management of Cisplatin Overdose

目的 探讨引起顺铂过量致毒性反应的原因及临床救治要点。方法 检索国内外数据库(截至2021年12月31日)中顺铂过量的相关病例,对其临床资料[性别、年龄、原发肿瘤、顺铂过量原因、用法用量、毒性反应表现、住院时长、处置及转归等]进行汇总分析。结果 21例符合条件,中位年龄47岁(1~67岁);涉及12种原发性肿瘤;顺铂过量的给药剂量为180~800 mg·m^(-2);顺铂过量的原因:处方错误18例,调剂错误2例,处方传递错误1例。顺铂过量常见的毒性反应依次是肾毒性(95%),耳毒性(86%),骨髓抑制(86%),肝毒性(48%),急性胰腺炎(19%),视力缺失(19%)和呼吸衰竭(19%)。因药物过量住院的时长为7~49 d,中位数是26 d。21例患者中,4例死亡(19%),17例存活(81%)。结论 应从多个层面预防顺铂过量,特别是常见的处方错误,以防引发毒性事件,保证患者用药安全。顺铂过量的救治要点包括充分水化、使用血浆置换尽快清除过量药物、避免使用肾毒性药物以及考虑使用细胞保护剂如氨磷汀和硫代硫酸钠。

OBJECTIVE To explore the clinical characteristics and management of cisplatin overdose.METHODS Relevant databases at home and abroad updated to December 31,2021 were searched to find the case reports of cisplatin overdose.The basic information of patients,indications of cisplatin,usage and dosage of cisplatin,toxicity,duration of hospitalization,and treatment and outcome of cisplatin overdose was descriptively analyzed.RESULTS A total of 21 patients were included in the analysis,aged from 1 to 67 years,involving in 12 kinds of primary tumors,dosage from 180-800 mg·m^(-2).Medication errors included prescription error(18 cases),dispensing errors(2 cases) and transcription errors(1 case).The most common toxicities of cisplatin overdose were nephrotoxicity(95%),ototoxicity(86%),myelosuppression(86%),hepatotoxicity(48%),acute pancreatitis(19%),vision loss(19%) and respiratory failure(19%).The length of hospital stay for drug overdoses was 7-49 days,with a median of 26 days.Of the 21 patients,4 died and 17 survived.CONCLUSION The key management points for cisplatin overdose are adequate hydration,prompt clearance of the overdose with plasmapheresis,avoidance of nephrotoxicity and consideration of chemoprotective agents such as amifostine and sodium thiosulfate.In order to prevent the recurrence of such accidents,it is suggested that the evaluation should be carried out at multiple levels to ensure the safety of patients.