| 摘要: |
| 目的:探讨甲氨蝶呤(MTX)中毒的原因及解救策略,以及医师和药师联合救治模式的益处。方法:患儿因急性淋巴细胞白血病于2016年12月7日在外院接受第2次大剂量甲氨蝶呤(HDMTX, 2.5 g/m2)化疗,常规给予亚叶酸钙(LCV)解救、水化等治疗。第42 h的MTX血浓度(MTX 42 h)为18.21 μmol/ L,通过追加LCV 解救剂量和积极水化,MTX 66 h为12.34 μmol/L,同时发现肝肾功能损害,考虑MTX中毒,12月10日转入我院儿科重症监护病房(PICU),经过22 h的血液灌流效果欠佳。根据医师和药师的综合分析,结合患儿情况,改用连续性静脉鄄静脉血液滤过(CVVH)清除体内MTX,血泵流速30 mL/min,滤过流速500 mL/h,补液泵流速500 mL/h,时间为MTX 118~144 h。结果:经过26 h的CVVH,MTX血药浓度快速下降,CVVH结束后,继续行LCV解救、水化,浓度渐降至0.25 μmol/L以下,未出现反跳,肝肾功能等生化指标逐渐降至正常。结论:连续性肾脏替代治疗成功解救MTX中毒的经验提示临床医师和临床药师联合诊治MTX中毒的模式值得推广。 |
| 关键词: 甲氨蝶呤 血液净化 血液灌流 连续性肾脏替代治疗 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.07.012 |
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| 基金项目: |
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| One Case of Methotrexate Poisoning Successfully Treated by Continuous Renal Replacement |
| Yu Lihua1 , Tao Shaohua1 , Lin Danna1 , Wen Luping2 , Wang Liqing2 , Yang Lihua1 |
| (1. Zhujiang Hospital of Southern Medical University, Guangdong Guangzhou 510282, China; 2. The Seventh Affiliated Hospital, Sun Yat-sen University, Guangdong Shenzhen 518107, China) |
| Abstract: |
| Objective: To probe into the causes of methotrexate(MXT) poisoning and its rescue strategies, and the benefits of the combined treatment model of physicians and pharmacists. Methods: Children with acute lymphoblastic leukemia received the second high-dose methotrexate (HDMTX, 2.5 g/m2 ) chemotherapy in the external hospital on Dec. 7th , 2016, and routine administration of levofloxacin (LCV) rescue and hydration. The MTX blood concentration of 42 h (MTX 42 h) was 18.21 μmol/L, after addition of LCV rescue dose and active hydration, the MTX of 66 h was 12.34 μmol/L, and the liver and kidney function of patient was found to be abnormal. Considering MTX poisoning, the patient was transferred to the pediatric intensive care unit (PICU) in our hospital on Dec. 10th , and the effect of 22 h hemoperfusion was poor. According to the comprehensive analysis of physicians and pharmacists, combined with the conditions of children, continuous veno-venous hemofiltration (CVVH) was used to remove in vivo MTX, the blood pump flow rate was 30 mL/min, the filtration flow rate was 500 mL/h, and the replacement pump flow rate was 500 mL/h for MTX 118~144 h. Results: MTX plasma concentration of patient decreased rapidly after 26 h of CVVH. The patients continued to receive LCV rescue and hydration until the concentration of MTX decreased to less than 0.25 μmol/L and the function of liver and kidney returned to normal state. Conclusion: The successful experience of using CRRT to rescue MTX poisoning suggests that the combination of clinicians and clinical pharmacists in the treatment of MTX poisoning is worth promoting. |
| Key words: methotrexate blood purification hemoperfusion continuous renal replacement |
