不同时间四氢叶酸钙解救大剂量甲氨蝶呤化疗毒副作用的研究  

Clinical research of calcium folinate rescue in high-dose methotrexate therapy at different times

作　　者：张秀萍[1] 裴忠利[1] 朱梅[1] 廉德花[1] 

机构地区：[1]山东省滕州市中心人民医院儿科,277500

出　　处：《中华现代护理杂志》2011年第15期1745-1748,共4页Chinese Journal of Modern Nursing

摘　　要：目的探讨不同时间四氢叶酸钙（CF）解救大剂量甲氨蝶呤（HDMTX）化疗毒副作用的临床效果。方法将符合标准的急性淋巴细胞白血病（ALL）患儿根据化疗例次随机分为两组，观察组为A组，对照组为B组，两组均采用的化疗方案包括诱导缓解治疗（VDLD），巩固治疗（CAT），庇护所预防（HDMTX＋CF），再诱导治疗的指导原则。庇护所预防治疗是A组应用大剂量甲氨蝶呤静注24h结束后，于12h给予四氢叶酸钙解救治疗。B组应用大剂量甲氨蝶呤静注6h结束后，于30h给予四氢叶酸钙解救治疗。观察两组患儿用药后的不良反应，特别是胃肠道反应，即恶心呕吐程度，口腔黏膜反应程度，白细胞反应程度，心、肝、肾、神经毒性反应情况及反应持续时间。结果两组患儿化疗后胃肠道反应程度，口腔黏膜反应程度，白细胞反应程度差异均有统计学意义（P〈0．05），且化疗后反应持续时间差异有统计学意义（P〈0．01）。化疗后心、肝、肾、神经毒性反应差异无统计学意义（P〉0．05）。结论不同时间四氢叶酸钙解救大剂量甲氨蝶呤化疗毒副反应有差异，两组均可降低毒性反应，但24h滴注HDMTX后12h给予CF解救，更有利于正常组织细胞损伤的修复，提高化疗效果和患儿生存质量和生存率，具有较好的临床应用价值。Objective To explore the clinical effects of calcium folinate （CF） rescue on high-dose methotrexate （HDMTX） therapy at different times. Methods Children with acute lymphocytic leukemia （ALL） who met the inclusion criteria were randomly divided into two groups in line with chemotherapy order： observation group （Group A） and control group （Group B ）. Chemotherapy regimens included remission induction chemotherapy （ VDLD ）, consolidation therapy （ CAT）, shelters to prevent （ HDMTX ＋ CF）, reinduction therapy. Group A was intravenously injected HDMTX for 24 hours and then rescued by CF for 12 hours. Group B was intravenously injected HDMTX for 6 hours and then rescued by CF for 30 hours. Side effects after administration of medicine were observed, in particular, the gastrointestinal tract reaction, which included nausea and vomiting, oral mucous membrane reaction, leukocyte reaction, the toxicity of the heart, liver, kidney, nerve and response durations. Results There were significant differences in both groups on response degree in the gastrointestinal tract reaction, oral mucous membrane reaction, and leukocyte reaction （P 〈 O. 01, P 〈 0. 05 ）; while there was significant difference in response duration after chemotherapy for both groups （P 〈 0.01 ）. There was no significant difference in the heart, liver, kidney, neurological toxicity reaction （ P 〉 0. 05 ）. Conclusions There are differences in side effects of CF rescue on HDMTX therapy at different times. Both groups could reduce the toxic reaction, but the protocol that gives HDMTX for 24 hours and then rescues by CF for 12 hours is more conducive to repair the normal tissue cell＇ s damage, improve chemotherapy efficacy and children＇ s quality of life, with a better clinical value.

关 键 词：四氢叶酸钙 甲氨蝶呤 毒性 解救 

分 类 号：R733.71[医药卫生—肿瘤]