1例紫杉醇注射液致急性疼痛综合征不良反应报道

A case report of acute pain syndrome induced by paclitaxel

1例55岁女性宫颈鳞癌患者接受姑息化疗(紫杉醇300 mg ivd d1+顺铂30 mg ivd d1、50 mg ivd d2)联合免疫治疗(卡瑞利珠单抗200 mg ivd d1)。第2周期治疗结束后出现双下肢弥漫性疼痛,第3周期停用紫杉醇后未再发生,第4周期继续使用紫杉醇后双下肢疼痛再次出现。紫杉醇的使用与双下肢疼痛的发生有明显的去激发和再激发反应。通过检索文献、查阅说明书等,判断该患者的双下肢弥漫性疼痛很可能系紫杉醇所致急性疼痛综合征,这是紫杉醇注射液说明书中未载明的一种新型不良反应。给予阿片类镇痛药联合非甾体抗炎药对症处理,患者疼痛明显缓解。本文首次报道了紫杉醇注射液的罕见急性疼痛综合征,提醒临床医生和药师在使用该药物时注意急性神经毒性的发生,为临床用药安全和肿瘤慢病管理提供参考。

A 55-year-old female patient with cervical squamous cell carcinoma received palliative chemotherapy(paclitaxel:300 mg ivd d1;cisplatin:30 mg ivd d1,50 mg ivd d2),combined with immunotherapy(carrelizumab 200 mg ivd d1).After the second cycle of treatment,the patient developed diffuse pain in the lower limbs.Then paclitaxel was stopped in the third cycle,and no pain occurred in the lower limbs.However,when paclitaxel was used again in the fourth cycle,the pain in both lower limbs occurred again.There was an obvious deexcitation and reexcitation reaction between the use of paclitaxel and the occurrence of pain in both lower limbs.Through searching literatures and consulting the medicine instruction,it was judged that the lower limbs pain of the patient was likely to be the acute pain syndrome caused by paclitaxel,which was a new adverse reaction not noted in the instruction of paclitaxel injection.After symptomatic treatment with opioid analgesics combined with non-steroidal anti-inflammatory drugs,the patient's pain was significantly relieved.This is the first report of a rare acute pain syndrome caused by paclitaxel injection,which reminds clinicians and pharmacists to pay attention to the occurrence of acute neurotoxicity when using this drug.It also provides reference for clinical medication safety and chronic tumor disease management.