放疗后使用贝伐珠单抗致气管纵隔瘘1例并文献复习  

A case of tracheomediastinal fistula associated with bevacizumab after radiation and literature review

作　　者：杜中英 柳芳[2] 崔慧娟[3] DU Zhongying;LIU Fang;CUI Huijuan(Dept.of Pharmacy,Qingdao Eighth People’s Hospital,Shandong Qingdao 266100,China;Dept.of Pharmacy,China-Japan Friendship Hospital,Beijing 100029,China;Oncology Department of Integrated Traditional Chinese and Western Medicine,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]青岛市第八人民医院药学部,山东青岛266100 [2]中日友好医院药学部,北京100029 [3]中日友好医院中西医结合肿瘤内科,北京100029

出　　处：《中国药房》2022年第12期1500-1505,共6页China Pharmacy

基　　金：首都卫生发展科研专项项目(No.首发2018-2-4065)。

摘　　要：目的为肿瘤患者安全使用贝伐珠单抗提供参考。方法回顾性分析临床药师参与的1例放疗后使用贝伐珠单抗致气管纵隔瘘患者的治疗过程,并检索PubMed、Elsevier Science Direct、Springer Link、Wiley Online Library、中国知网、万方数据等数据库,收集贝伐珠单抗致相关呼吸道瘘的案例,分析气管纵隔瘘的形成原因。结果与结论临床药师参考相关文献,结合瘘口形成位置并考虑其与贝伐珠单抗使用时间的关联性,考虑该病例可能为贝伐珠单抗致相关气管纵隔瘘,建议患者停用贝伐珠单抗并行支架植入术。患者因个人原因拒绝植入支架,但停药3个月后其气管纵隔瘘有所改善。结合收集到的16例贝伐珠单抗致呼吸道瘘患者的资料可以推测,在放疗基础上使用贝伐珠单抗可能是气管纵隔瘘发生的原因,其机制可能与贝伐珠单抗可抑制新生血管形成、影响伤口愈合有关。这提示对于接受过放疗的患者,在使用贝伐珠单抗时,临床药师要加强用药监护和用药教育;临床药师除关注该药致高血压、出血等常见不良反应外,还应重视呼吸道瘘等罕见但可危及生命的不良反应,以保证患者的用药安全。OBJECTIVE To provide reference for safe use of bevacizumab in tumor patient. METHODS Retrospective analysis was performed for a case of tracheomediastinal fistula caused by bevacizumab after radiotherapy in which clinical pharmacist participated. Retrieved from PubMed, Elsevier Science Direct, Springer Link, Wiley Oline Library, CNKI and Wanfang database,the cases of respiratory fistula caused by bevacizumab were collected,and the causes of respiratory fistula were analyzed. RESULTS & CONCLUSIONS Referring to relevant literatures,combined with the formation position of fistula and considering its correlation with the use time of bevacizumab,considering that it may be bevacizumab related tracheomediastinal fistula,clinical pharmacists recommended that patients stopped bevacizumab and underwent stent implantation. The patient refused to implant stent for personal reasons,but the tracheomediastinal fistula improved 3 months after drug withdrawal. Combined with the data of 16 patients with respiratory fistula caused by bevacizumab,it could be inferred that the use of bevacizumab on the basis of radiotherapy may be the cause of tracheomediastinal fistula;the mechanism may be related to bevacizumab inhibiting angiogenesis and affecting wound healing. This suggests that for patients who have received radiotherapy,clinical pharmacists should strengthen medication monitoring and medication education when using bevacizumab;clinical pharmacists should not only pay attention to the common adverse reactions such as hypertension and bleeding caused by the drug,but also pay attention to rare but life-threatening adverse reactions such as respiratory fistula,so as to ensure the safety of drug use.

关 键 词：贝伐珠单抗 放疗 气管纵隔瘘 呼吸道瘘 临床药师 

分 类 号：R969.3[医药卫生—药理学] R562.1[医药卫生—药学]