【作者】 乐少华；

【导师】 陈燕惠；

【作者基本信息】 福建医科大学 ， 儿科学， 2008， 硕士

【摘要】 目的观察大剂量甲氨喋呤(high-dose methotrexate,HD-MTX)治疗小儿急性淋巴细胞白血病(ALL)产生的毒副作用,研究其预防措施。方法40例ALL患儿接受150例次HD-MTX(每次3.0g/m~2)治疗,经综合预防措施后,观察临床症状、体征和实验室指标,总结HD-MTX副作用发生的种类、发生率及临床疗效,并比较充分水化与未充分水化者粘膜炎、皮疹发生率及白细胞、血小板、谷草转氨酶、肌酸肌酶-MB的变化。结果胃肠道反应、肝功能损害、口腔粘膜炎、骨髓轻度抑制是HD-MTX常见的不良反应,未充分水化者其口腔粘膜炎、皮肤过敏反应的发生率较充分水化者高(P＜0.05),而白细胞、血小板下降,谷草转氨酶升高均较充分水化组明显(P＜0.05),肌酸肌酶-MB两组比较无明显差异(P＞0.05)。结论充分水化碱化,适宜四氢叶酸钙解救,可有效降低HD-MTX毒副反应的发生率。更多还原

【Abstract】 AIM: To observe the toxic side effects of high-dose methotrexate(HD-MTX) on acute lymphoblastic leukenia(ALL), and to investigate the measures for preventing complications.METHODS: 40 children with ALL received 150 times HD-MTX treatment (3.0g/m~2,every time).The comprehensive measures for preventing complications were taken after chemotherapy. The clinical symptoms and the main toxic side effects were observed, and compare with the rate of mucositis and skin rash, the variation of WBC、PLT、ALT and CK-MB between adequate and inadequate hydration children.RESULTS: Gastrointestinal reaction, hepatic damage, dental ulcer, slight depression of bone marrow were the common adverse effects of HD-MTX. Compare to adequate hydration children, the incidence rate of mucositis and skin rash were higher, the variation of WBC、PLT were decreased significantly, and the variation of ALT were increased significantly in inadequate hydration ones (P<0.05). As for CK-MB, there was no significantly variance between inadequate hydration and adequate hydration children (P>0.05).CONCLUSION:Adequate hydration and alkalihization, correct calcium folinate rescue can reduce effectually the rate of the toxic side effects of HD-MTX .更多还原