摘要
目的总结1例骨肉瘤患者大剂量甲氨蝶呤(methotrexate,MTX)化疗后血药浓度持续居高不下的情况及原因。方法患者滴注10 g MTX后,测得24、48、72 h点血药浓度分别为180.0μmol/L、57.0μmol/L、20.4μmol/L,治疗过程中连续监测MTX血药浓度变化,指导以甲酰四氢叶酸钙(calcium folinate,CF)注射剂解救患者,并控制不良反应。通过文献总结,从MTX的体内代谢过程、药理作用、不良反应、影响血药浓度因素等方面,分析造成此现象的可能原因。结果患者经过CF等解救药物的18 d治疗,肝肾功能、神志、精神、饮食恢复正常;给药后432 h点(18 d)MTX血药浓度下降至0.15μmol/L。结论通过及时的血药浓度测定和药代动力学监护,关注患者的严重不良反应,为临床救治提供了有效的技术支持。
Objective To illustrate the reason for methotrexate（methotrexate,MTX） concentration in serum remained high after chemotherapy with high-dose in one patient with osteosarcoma.Methods After intravenous infusion of 10 g MTX,the plasma concentrations of MTX were 180 μmol / L,57.0 μmol / L and 20.4 μmol / L at 24,48 and 72 h,respectively.We determined serum MTX concentration continuously and found that the concentration of MTX lasted high during the process of treatment.Then the calcium folinate（CF） injection was controlled to avoid the toxic and side-effect brought by MTX.We analyzed the possibilities of the phenomenon from the disposition,pharmacological effects,adverse reactions and the factors affecting serum MTX concentration.Results After18 d treatment with CF and other rescue medicine,the patient had resumed normal liver and kidney function,consciousness and diet.The serum concentration decreased to 0.15 μmol / L at 432 h（18 d） after the administration of MTX.Conclusion Pharmacists provide effective treatments and clinical benefits through timely monitoring of serum drug concentration and adverse drug reactions.
出处
《东南国防医药》
2015年第2期119-121,172,共4页
Military Medical Journal of Southeast China
基金
江苏省第七批"六大人才高峰"资助项目(2010WSN-204)
