应用紫杉类药物前激素预处理的改进及过敏后再输入的探讨

A study of steroid premedication for hypersensitivity reaction and reinfusion in taxane family regimen

目的 探索简便可靠的紫杉类药物激素预处理方法以及重度过敏反应后再输入的可能性。方法 共 4 83例肺癌病例进行 1 4 0 1疗程以紫杉类为主的化疗 ,其中 2 1 2例、4 1 6疗程采用常规法激素预处理 ,即在注药前 1 2小时及 6小时各口服地塞米松 1 0mg ,再在注紫杉类药物前 30分钟肌注苯海拉明 4 0mg ,静注西米替丁 30 0mg ;另外 2 70例、985疗程采用简化法激素预处理 ,即在静脉点滴紫杉类药物前 6 0分钟 ,将地塞米松 1 0mg加入 1 0 %葡萄糖 5 0 0ml静滴 ,再在注药前 30分钟将地塞米松 1 0mg、苯海拉明 2 0mg、西米替丁 30 0mg经滴壶先后加入。结果 紫杉类药物过敏反应发生率在常规激素预处理组1 1 .3% ,在简化预处理组 1 2 .5 % ,两组差异无统计学显著性 (P >0 .0 5 )。两组发生重度 (Ⅲ +Ⅳ度 )过敏反应分别为 8例(3.8% ) ,1 2例 (4 .4 % ) ,即共 2 0例重度过敏反应病例经紧急处理又将余下紫杉类药液顺利完成再输入。结论 简化激素预处理法对预防减轻紫杉类药物过敏反应具有简便易行。

Objective To investigate a simple method to manage severe hypersensitivity reaction for continuing administration taxane family. Methods 1401 course taxane family regimen of 483 lung cancer cases was managed with routine steroid premedication (control group) and simplified steroid premedication (experimental group). In 416 course of 212 cases control group, dexamethasoni 10mg were given orally 12 hours and 6 hours before infusion of taxane, and 30 minutes before injection of taxane dimenhydrinate 20mg, cemitidi 300mg was given. In 985 course of 270 cases experimental group, 60 minutes before infusion of taxane, dexamethasoni 10mg plus 10% glucosi 500ml was given, 30 minutes later, dexamethasoni 10mg, dimenhydrinate 20mg cemitidi 300mg was administrated.Results Hypersensitivity reaction rate in control group was 11.3 % and 12.5 % in experimental group (P>0.05). Severe hypersensitivity reaction (Ⅲ+Ⅳ degree) was observed 8 cases ( 3.8 %) and 12 cases ( 4.4 %) respectively in control group and experimental group, and 20 cases hypersensitivity reactions were controlled by steriod premedication and remained taxane were reinfused.Conclusion Simplified steroid premedication is safe and simple method in taxane hypersensitivity reaction treatment.