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为探讨大剂量甲氨喋呤在小儿髓外白血病防治中的药代动力学改变及血药浓度监测的临床意义 ,对52例为预防髓外白血病的急性淋巴细胞白血病患儿 ,应用大剂量甲氨喋呤 (3.0～5.0g/m2)治疗1～3个疗程 ,每疗程进行3次血药浓度监测。结果显示 ,开始静脉滴注后24h甲氨喋呤血清药物浓度出现峰值 ,48h明显下降 ,72h绝大多数患儿血药浓度回复到投药前水平。提示根据测定的甲氨喋呤血药浓度水平 ,可适当增加甲氨喋呤的药物剂量以增强防治髓外白血病的疗效 ,或增加解救药物的剂量和给药次数 ,以减少其毒副作用 ,指导临床治疗。
In order to investigate the pharmacokinetics of high-dose methotrexate in the prevention and treatment of pediatric extramedullary leukemia and the clinical significance of blood concentration monitoring, 52 cases of children with acute lymphoblastic leukemia to prevent extra-leukemia, the application of high-dose Aminopterin (3.0 ~ 5.0g / m2) treatment of 1 to 3 courses of treatment for each course of blood drug concentration monitoring. The results showed that 24h after the start of intravenous infusion of methotrexate serum drug concentration peak, decreased significantly 48h, 72h the vast majority of children plasma concentration returned to pre-dose levels. It is suggested that the dose of methotrexate may be appropriately increased to enhance the efficacy of prevention and treatment of extramedullary leukemia or to increase the dosage and administration times of the rescue medication so as to reduce the toxic and side effects according to the determined blood level of methotrexate. Clinical treatment.