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目的:研究非霍奇金淋巴瘤患者大剂量甲氨蝶呤(HD-MTX)24 h滴注疗法延迟排泄影响因素、不良反应和解救措施。方法:收集某院2009-2014年之间122个患者的377次疗程的HD-MTX24 h滴注疗法的资料,运用统计学方法分析延迟排泄和疗程、年龄、性别、剂量、血药浓度及不良反应的相关关系,探讨了延迟排泄的解救措施。结果:延迟排泄发生率与疗程、年龄、性别无关,但与剂量相关,当剂量大于4.0g时发生率高。延迟排泄患者滴注完12 h以后的MTX血药浓度明显升高,高浓度MTX延迟排泄的可引起肾功能损伤。结论:延迟排泄更多发生在低浓度点,但高浓度的延迟排泄肾功能损伤大,因此血药浓度监测是实施HD-MTX疗法必不可少的安全保证措施。在及时的亚叶酸钙(CF)解救和充分的水化碱化下,延迟排泄的不良反应完全可以很好地预防和控制。
Objective: To study the influencing factors of delayed excretion, adverse reactions and rescue measures of high-dose methotrexate (HD-MTX) 24 h drip therapy in patients with non-Hodgkin’s lymphoma. METHODS: Data from 377 sessions of HD-MTX 24 h instillation were collected from 122 patients in a hospital from 2009 to 2014. Delayed excretion and course of treatment, age, sex, dose, plasma concentration, and toxicity were analyzed using statistical methods Response, and discussed the rescue measures of delayed excretion. Results: The incidence of delayed excretion was independent of course of treatment, age and gender, but was dose-related. The incidence of delayed excretion was higher when the dose was greater than 4.0g. Delayed excretion of patients after 12 h infusion of MTX blood concentration was significantly increased, high concentrations of MTX delayed excretion can cause renal damage. CONCLUSIONS: Delayed excretion occurs more frequently at low concentrations, but high levels of delayed excretion impair renal function. Therefore, monitoring of plasma concentrations is an essential safety measure for HD-MTX therapy. With timely rescue of leucovorin (CF) and adequate hydration and alkalinization, the adverse effects of delayed excretion can be well prevented and controlled.