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1例14岁女性患儿因淋巴瘤Ⅳ期入院进行第16次化疗。入院时实验室检查示WBC 5.58×109/L,Hb 88 g/L,PLT143×109/L,SCr 42μmol/L,ALT 38 U/L,心、肝、肾功能大致正常。化疗方案:MTX总量4 g,其中1/3总剂量0.5 h内静脉给予,剩余剂量在随后的23.5 h内静脉给予。同时给予地塞米松5 mg+阿糖胞苷40 mg+MTX 12.5 mg鞘内注射,并静脉给予长春新碱1.8 mg。化疗第2天,患儿出现发热、呕吐、腹泻、下肢水肿。第3天实验室检查示WBC 2.49×109/L,PLT 24×109/L,Hb 58.0 g/L;K+2.74 mmol/L,SCr 179μmol/l,CK 1 089 U/L。化疗后24、42 h患儿MTX血药浓度分别为168.0和65.0μmol/L。血液净化治疗期间,MTX血药浓度分别为36.5μmol/L(66 h)、29.4μmol/L(73 h)2、2.1μmol/L(77 h)和16.0μmol/L(90 h)。化疗第5天患儿尿量降至460 mL,随后无尿,并出现全身抽搐,静脉给予地西泮5 mg后抽搐缓解,但仍有躁动。
A 14-year-old female patient underwent 16th chemotherapy for stage IV of lymphoma admission. Laboratory tests showed that WBC 5.58 × 109 / L, Hb 88 g / L, PLT143 × 109 / L, SCr 42μmol / L and ALT 38 U / L on admission. The heart, liver and kidney function were normal. Chemotherapy: MTX total 4 g, of which 1/3 of the total dose within 0.5 h intravenously, the remaining dose within the next 23.5 h intravenously. At the same time dexamethasone 5 mg + cytarabine 40 mg + MTX 12.5 mg intrathecal injection, and intravenous vincristine 1.8 mg. Day 2 of chemotherapy, children with fever, vomiting, diarrhea, lower extremity edema. On the third day, laboratory tests showed WBC 2.49 × 109 / L, PLT 24 × 109 / L, Hb 58.0 g / L; K + 2.74 mmol / L, SCr 179μmol / L, CK 1 089 U / L. The MTX plasma concentrations in children 24 and 42 h after chemotherapy were 168.0 and 65.0 μmol / L, respectively. During the blood purification treatment, MTX plasma concentrations were 36.5 μmol / L (66 h), 29.4 μmol / L (73 h), 2.2.1 μmol / L (77 h) and 16.0 μmol / L (90 h), respectively. On the fifth day after chemotherapy, the urinary output dropped to 460 mL, followed by anuria and generalized convulsions. After the intravenous diazepam was given at 5 mg, convulsions were relieved, but there was still restlessness.