异环磷酰胺脑病全身抽搐发作表现1例并文献回顾

A Case of Ifosfamide Encephalopathy Characterized by Generalized Convulsions and Literature Review

目的:整理、分析异环磷酰胺致中枢神经系统毒性的临床特点、危险因素、影像学及电生理特点、治疗及预后,为临床及早发现和治疗异环磷酰胺脑病提供参考。方法:参与1例异环磷酰胺致中枢神经系统毒性患者的治疗过程。该患者行第3疗程异环磷酰胺方案化疗第4天时出现全身抽搐症状,查体示肌张力增高、病理征阳性,经多学科会诊后,考虑该不良反应与异环磷酰胺有关,停用该药并给予支持治疗后24小时内症状好转。结合上述病例,收集异环磷酰胺致中枢神经系统毒性的相关文献,归纳、总结其临床表现、发病机制、危险因素、干预及转归等特征。结论:神经系统毒性为异环磷酰胺的罕见不良反应,多发生在用药后12小时到6天内,可表现为嗜睡、昏迷、全身抽搐发作等多种症状。当患者出现该不良反应时,应及时停药并给予支持治疗,必要时静脉给予亚甲蓝或硫胺素治疗。临床医师应加强对异环磷酰胺神经系统毒性的认识,及时识别相关症状,保证用药安全。

Objective: To summarize and analyze the clinical characteristics, risk factors, imaging and electro-physiological characteristics, treatment and prognosis of central nervous system toxicity induced by ifosfamide, and to provide reference for early detection and treatment of ifosfamide encephalopa-thy. Methods: The researcher participated in the treatment of a patient with central nervous system toxicity caused by ifosfamide. On the fourth day of the third course of ifosfamide chemotherapy, the patient developed generalized convulsions, increased muscle tone, and positive pathological signs. After multi-disciplinary consultation, considering that the adverse reaction was related to ifosfamide, symptoms improve within 24 hours after discontinuation of medication and supportive treatment. Combined with the above cases, collecting relevant literatures on central nervous sys-tem toxicity induced by ifosfamide, and their clinical manifestations, pathogenesis, risk factors, in-tervention and outcome were summarized. Conclusion: Neurotoxicity is a rare adverse reaction of ifosfamide, which occurs within 12 hours to 6 days after administration. It can be manifested as drowsiness, coma, generalized seizures and other symptoms. When the patient has this adverse re-action, the drug should be discontinued in time and supportive treatment should be given. If nec-essary, methylene blue or thiamine should be given intravenously. Clinicians should strengthen the understanding of the neurotoxicity of ifosfamide, timely identify related symptoms, and ensure the safety of medication.