博来霉素诱发间质性肺炎致死亡  

Death due to interstitial pneumonia associated with bleomycin

作　　者：齐冰丽 马艳丽[2] 刘世凯[1] Qi Bingli;Ma Yanli;Liu Shikai(Third Department of Gynecologic Tumor Surgery,Cangzhou Central Hospital,Hebei Province,Cangzhou 061000,China;Department of Pharmacy,Cangzhou Central Hospital,Hebei Province,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院妇科肿瘤外三科,沧州061001 [2]河北省沧州市中心医院药学部,沧州061001

出　　处：《药物不良反应杂志》2022年第12期670-672,共3页Adverse Drug Reactions Journal

摘　　要：1例51岁女性卵黄囊瘤患者行卵巢癌全面分期手术后接受BEP方案化疗,具体方案为博来霉素(30-mg肌内注射,第2、9、16天)+依托泊苷[100-mg/(m^(2)·d)静脉滴注、第1~5天]+顺铂[20-mg/(m^(2)·d)静脉滴注、第1~5天],21 d为1个周期。术前及每个化疗周期前胸部CT均未发现肺部有间质性改变。治疗第4个周期第12天,患者出现咳嗽、咳痰,实验室检查:白细胞计数0.63×10^(9)/L,中性粒细胞计数0.16×10^(9)/L,血红蛋白82-g/L,血小板计数42×10^(9)/L。胸部CT示两肺少许网格影。诊断为骨髓抑制(Ⅳ度),肺部感染。未行第4周期第3周博来霉素治疗。给予粒细胞集落刺激因子、血小板生成素、美罗培南、溴己新及输血、补液等对症支持治疗后,骨髓抑制缓解,但咳嗽、咳痰症状加重,复查胸部CT示间质性肺炎。考虑与博来霉素有关,加用糖皮质激素、两性霉素B等,并给予无创呼吸机辅助通气等对症支持治疗,但患者病情加重,于第4周期化疗后45 d发生呼吸衰竭并死亡。A 51-year-old patient with yolk sac tumor received BEP regimen[intramuscular injection of bleomycin 30-mg,on day 2,9,and 16),IV infusions of etoposide 100-mg/(m^(2)·d)and cisplatin 20-mg/m^(2)on day 1 to 5]after comprehensive staging surgery for ovarian cancer,21 days was a cycle.No interstitial changes in her lungs were found on chest CT before operation and before each chemotherapy cycle.On the 12th day of the 4th treatment cycle,the patient developed cough,expectoration.Laboratory tests showed white blood cell count 0.63×10^(9)/L,neutrophil count 0.16×10^(9)/L,hemoglobin 82-g/L,platelet count 42×10^(9)/L.Chest CT showed a little grid shadow in both lungs.The patient was diagnosed with myelosuppression(gradeⅣ)and pulmonary infection.Bleomycin treatment in the 3rd week of the 4th cycle was stopped.Granulocyte colony stimulating factor,thrombopoietin,meropenem,bromhexine,blood transfusion,fluid infusion,and other symptomatic and supportive treatment were given.Bone marrow suppression was relieved,but cough and expectoration were aggravated.Chest CT showed a little grid shadow in both lungs.Glucocorticoid and amphotericin B were added,and non-invasive ventilator assisted ventilation and other symptomatic support treatments were given,but the patient′s condition worsened,and respiratory failure and death occurred 45 days after the 4th cycle of chemotherapy.

关 键 词：博来霉素 肺炎 肺疾病 间质性 卵巢肿瘤 

分 类 号：R563.13[医药卫生—呼吸系统]