临床药师参与一例大剂量甲氨蝶呤过敏反应处理及成功脱敏再应用的药学实践  

Pharmaceutical practice in the treatment,desensitization and reapplication of high-dose methotrexate of a patient with anaphylaxis induced by high-dose methotrexate

作　　者：孙习鹏[1] 李星霞[1] 陈燕[1] 郭澄[1] SUN Xi-peng;LI Xing-xia;CHEN Yan;GUO Cheng(Aepartment of Pharmacy,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院药剂科,上海200233

出　　处：《中国药物应用与监测》2020年第6期378-380,共3页Chinese Journal of Drug Application and Monitoring

基　　金：2018年上海市“医苑新星”青年医学人才培养资助计划。

摘　　要：1例14岁男性患者,临床诊断为左股骨骨肉瘤伴双肺转移。入院行第一次大剂量甲氨蝶呤(10 g·m^-2)方案治疗,输注甲氨蝶呤15 min患者出现呼吸困难、发热、盗汗、震颤等过敏反应,对症治疗后好转。临床医生咨询临床药师是否可以再次使用大剂量甲氨蝶呤治疗,临床药师建议化疗前使用地塞米松、异丙嗪和西咪替丁预防过敏,同时增加溶媒体积,降低甲氨蝶呤药物浓度;输注时间由4 h延长到6 h,初始1 h输注总量的4%,第2小时输注总量的8%,4 h内输注完剩余的88%。临床医生予以采纳,患者成功脱敏再应用大剂量甲氨蝶呤,甲氨蝶呤血药峰浓度达到791.60μmol·L^-1,顺利完成化疗。One 14-year-old male patient diagnosed as osteosarcoma of the left femur with double lung metastases.He was treated with high-dose methotrexate(10 g·m^-2)for the first time.He developed dyspnea,fever,perspire and tremor 15 minutes later,which was relieved after symptomatic treatment.And then physicians asked clinical pharmacist whether high-dose methotrexate could be used in this patient again.Clinical pharmacist suggested to use dexamethasone,promethazine and cimetidine before chemotherapy for antianaphylaxis,increase the volume of solvent for reducing the concentration of methotrexate,and extend the infusion time of high-dose methotrexate from 4 hours to 6 hours as follows:4%of the total dose was administered in the first hour,8%of the total dose was administered in the second hour and the rest 88%of the total dose was administered in 4 hours.The patient successfully desensitized and used high-dose methotrexate again.The peak plasma concentration of methotrexate reached to 791.60μmol·L^-1 and the chemotherapy successfully completed.

关 键 词：临床药师 甲氨蝶呤 过敏反应 脱敏再应用 药学实践 

分 类 号：R979.1[医药卫生—药品]