大剂量甲氨蝶呤排泄延迟个体化治疗一例  

A case of individualized therapy with delayed excretion of high-dose

作　　者：赖冉 杨珺 LAI Ran;YANG Jun(Department of Pharmacy,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,and Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Pharmacy,the Affiliated Hospital of Xuzhou Medical University,Jiangsu Xuzhou 221002,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学中心、中国医学科学院北京协和医学院肿瘤医院药剂科,北京100021 [2]徐州医科大学附属医院药学部,江苏徐州221002

出　　处：《临床药物治疗杂志》2024年第8期87-89,共3页Clinical Medication Journal

基　　金：白求恩·求索-药学科研能力建设项目(Z04JKM2021005)。

摘　　要：本文报道1例中枢弥漫大B细胞淋巴瘤老年患者确诊后给予大剂量甲氨蝶呤方案化疗,化疗24 h后甲氨蝶呤血药浓度达到47.25μmol/L,提示甲氨蝶呤早期排泄延迟,同时肌酐、尿酸进行性上升。临床药师在大剂量甲氨蝶呤滴注速度的选择、抢救时机和亚叶酸钙抢救方案、分析甲氨蝶呤血药浓度影响因素、药物相互作用、水化、碱化等预处理方案制订,以及药学监护等发挥了积极作用,经医护人员和临床药师的共同努力,患者病情平稳后出院。This paper reports an elderly patient with central diffuse large B lymphoma who was given a high-dose methotrexate regimen after diagnosis.The concentration of methotrexate in the patient reached 47.25μmol/L 24 h after chemotherapy,suggesting that the early excretion of methotrexate was delayed,while creatinine and uric acid were progressively increased.Clinical pharmacists played an active role in the selection of high-dose methotrexate infusion speed,rescue time,formulation of calcium folinate rescue plan,analysis of factors affecting methotrexate blood concentration,drug interaction,formulation of hydration,alkalization and other pretreatment plans,and pharmaceutical care,etc.The patient was finally discharged after a stable condition through the joint efforts of medical staff and clinical pharmacists.

关 键 词：大剂量甲氨蝶呤 中枢弥漫大B细胞淋巴瘤 排泄延迟 个体化治疗 

分 类 号：R969.3[医药卫生—药理学]