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目的 ABVD化疗方案中博来霉素治疗指数较低,本文报道1例死亡病例供临床参考,旨在提示临床谨慎应用。方法报道1名74岁的中国男性患者因发热、咳嗽入院,经诊断为经典霍奇金淋巴瘤合并肺结核。采用ABVD化疗方案,第1天给予多柔比星35 mg,长春地辛4 mg,达卡巴嗪500 mg,博来霉素15 mg。结果患者给予博来霉素20 min后,体温突然升至41℃并伴有呼吸困难、多汗、昏迷症状,血压下降至108/58 mmHg,患者最后死于多器官功能衰竭。结论对于合并肺结核的老年霍奇金病患者特别是年龄>70岁者,应该谨慎选择含有博来霉素的化疗方案。并且在充分给予预防用药后,首先使用1 mg的博来霉素进行预实验,如果没有不良反应发生才能全剂量给药。
The purpose of the ABVD chemotherapy in bleomycin treatment index is low, this article reported a case of death for clinical reference, designed to prompt the clinical application of caution. Methods A 74-year-old Chinese male patient was admitted to hospital for fever and cough and was diagnosed with classic Hodgkin’s lymphoma with tuberculosis. With ABVD chemotherapy, doxorubicin 35 mg, vindesine 4 mg, dacarbazine 500 mg and bleomycin 15 mg were administered on day 1. Results Bleomycin 20 min after the temperature suddenly rose to 41 ℃ and accompanied by dyspnea, hyperhidrosis, coma symptoms, blood pressure dropped to 108/58 mmHg, the patient eventually died of multiple organ failure. Conclusions Elderly patients with Hodgkin’s disease who have tuberculosis, particularly those> 70 years of age, should be treated carefully with bleomycin-containing chemotherapy regimens. And after adequate prophylaxis, pre-test with 1 mg of bleomycin is first performed and full dose if no adverse reactions occur.