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目的:探讨鞘内注射甲氨蝶呤(MTX)治疗白血病不良反应的发生规律,指导临床合理用药。方法:对1979～2007年时间段国内文献15例鞘内注射甲氨蝶呤治疗白血病不良反应进行分析,及对2514例次鞘内注射甲氨蝶呤引发的不良反应进行分析。结果:鞘内注射后发生不良反应的男性11例占73.33%,女性4例占26.67%,例数男性多于女性,且平均年龄男性小于女性。从文献中有关MTX鞘内注射ADR个例报道的15例患者ADR分布看,双下肢麻木和软瘫占比例较大,但从临床治疗研究白血病的文献报道分析,鞘内注射MTX后发生的ADR以头痛、头晕(338次,13.44%)、恶心、呕吐(251次,9.98%)和发热(127次,5.05%)为主,仅有0.12%的人发生软瘫、0.44%的人出现双下肢麻木,死亡率0.2%。结论:应重视鞘内注射甲氨蝶呤不良反应,加强临床用药监护。
Objective: To investigate the incidence of adverse reactions of intrathecal methotrexate (MTX) in the treatment of leukemia and to guide clinical rational use of drugs. Methods: The domestic literature from 1979 to 2007 15 cases of intrathecal methotrexate treatment of leukemia adverse reactions were analyzed, and 2514 cases of intrathecal injection of methotrexate-induced adverse reactions were analyzed. Results: There were 11 males (73.33%) with adverse reactions after intrathecal injection and 26.67% females (4 females), with a greater number of males than females and a mean age of males less than females. From the literature on ADR intrathecal injection of MTX reported in 15 cases of ADR distribution, the lower extremity numbness and soft paralysis accounted for a larger proportion, but from the clinical treatment of leukemia reported in the literature, intrathecal injection of MTX ADR Nausea and vomiting (251 episodes, 9.98%) and fever (127 episodes, 5.05%) were the main symptoms of headache, dizziness (338 episodes, 13.44%), and only 0.12% Lower limb numbness, the mortality rate of 0.2%. Conclusion: It is necessary to pay attention to intrathecal methotrexate adverse reactions and to strengthen the monitoring of clinical medication.