甲苯磺酸索拉非尼致晚期肝癌患者高热伴皮疹

男性患者,56岁,因晚期原发性肝癌服用推荐剂量的索拉非尼(0.4 g,q12h)治疗。用药8 d后出现发热,体温最高至39.3℃。用药11 d开始出现皮疹,再次入院。入院后停用索拉非尼并给予抗过敏治疗,5 d后症状消退。随后给予低剂量索拉非尼(0.2 g,q12h),未出现发热及皮疹。5 d后索拉非尼加至0.4 g,q12h,治疗1 d后再次出现高热及新发皮疹。遂再次停用索拉非尼,高热及皮疹渐退。停用3 d后再次降低剂量至0.2 g,q12h。患者生命体征平稳、无畏寒、发热,无新发皮疹,病情稳定。该病例可为临床医生诊断索拉非尼引起的药物热及处理方法提供借鉴。     

1例索拉非尼治疗甲状腺癌致高血压亚急症的药学监护

目的探讨索拉非尼致高血压的特点、处理原则及药学监护。方法临床药师通过回顾国内外关于索拉非尼致高血压的文献,就此例患者的不良反应进行关联性分析,并实施药学干预和药学监护。结果此例患者在使用索拉非尼治疗近2周时出现高血压亚急症,及时停药并给予降压治疗后,患者血压可控制平稳,并继续索拉非尼治疗。结论临床药师应积极参与MDT模式下的靶向药物不良反应管理。发生索拉非尼相关性高血压时,应根据患者临床症状、高血压分级和用药史,采取合适的处理措施,最大化靶向药物的临床疗效。     

62例晚期肿瘤患者索拉非尼靶向治疗致不良反应的原因及其护理对策

目的:分析晚期肿瘤患者索拉非尼靶向治疗致不良反应的原因及其护理对策。方法:选取2012年2月—2015年2月期间收治的采用索拉非尼靶向治疗的晚期肿瘤患者62例,分析索拉非尼靶向治疗致不良反应的原因与护理方法。结果:62例患者经索拉非尼治疗后,其中致皮疹患者25例次、手足综合征患者21例、血压升高患者19例、肠胃道不适患者7例,尚未出现病死患者。结论:晚期肿瘤患者索拉非尼靶向治疗致不良反应症状较轻微,未出现严重的并发症。     

索拉非尼治疗原发性肝癌的不良反应分析

目的分析索拉非尼在国人中治疗原发性肝癌患者过程中出现的不良反应的特征。方法对在该科应用索拉非尼治疗原发性肝癌的30例患者的各种可能与应用索拉非尼有关的不良反应进行分级、记录与统计分析。结果观察到患者出现的与服用索拉非尼有关的不良反应主要为手足综合征、血压升高、脱发、腹泻、疲乏等。结论国人应用索拉非尼患者手足综合征、高血压、腹泻的发生率较高,亦可观察到骨髓抑制及肾功能损害,不良反应一般为轻中度,患者大多可以耐受,不需特殊处理。对于部分严重不良反应,予以停药或对症处理后均恢复正常。     

静脉滴注莫西沙星致精神异常

1例79岁女性患者因医院获得性肺炎给予莫西沙星400mg,1次／d静脉滴注。当晚患者出现自言自语、焦虑,血压135／85mmHg（1mmHg=0．133kPa）。医嘱维持抗感染治疗。此后患者精神症状加重,表现为不认识家人、应答不切题、幻觉、狂躁不安等。应用莫西沙星5d后血压升至190／110mmHg,体温39．6℃,脑电图无异常。停用莫西沙星,改用美罗培南0．5g,1次／8h静脉滴注;并给予厄贝沙坦控制血压。2d后患者精神症状缓解,血压、体温恢复正常。2周后随访,出院后未再应用厄贝沙坦,血压基本正常,未再出现精神症状。     

索拉非尼滥用致肝损害

1例60岁男性患者肾癌术后自行口服索拉非尼0.2 g、2次/d。2个月后患者出现全身乏力伴巩膜黄染、尿黄。实验室检查：总胆红素（TBil）146μmol/L,直接胆红素（DBil）94μmol/L,丙氨酸转氨酶（ALT）959 U/L,天冬氨酸转氨酶（AST）1150 U/L,γ-L-谷氨酰转肽酶（γ-GT）507 U/L。停用索拉非尼,给予三磷酸胞苷二钠、还原型谷胱甘肽、腺苷蛋氨酸治疗。24 d后复查肝功能：TBil 19μmol/L,DBil 10μmol/L,ALT 54 U/L,AST 40 U/L,γ-GT 22 U/L。     

索拉非尼引起移植肝肝功能异常1例

[摘要]索拉非尼是近年来研制的一个口服多靶点抗肿瘤药物,它可显著延长晚期肝细胞癌患者生存时间,但其对肝功能是否有影响尚不清楚。给予索拉非尼治疗1例原发性肝细胞癌行肝移植术后11个月出现双肺转移的患者,服用索拉非尼3个月后肺内转移灶数目减少、体积缩小,但服药2周后患者转氨酶开始持续升高,此期间胆红素水平正常,无巨细胞病毒感染及乙肝活动证据。肝组织学检查见类似急性排斥反应表现。停用索拉非尼后转氨酶开始下降,3周后恢复正常。提示索拉非尼可抑制肺转移性肝癌的生长,但可能导致移植肝肝功能的损害。     

DC-CIK生物疗法联合索拉非尼对原发性肝癌患者疗效及免疫功能的影响

目的 探讨DC-CIK生物疗法联合索拉非尼对原发性肝癌患者的治疗效果及免疫功能的影响.方法 选取2015年3月至2016年4月肿瘤科就诊的原发性肝癌患者78例,随机分为对照组和观察组,每组39例.对照组患者采用索拉非尼(0.4 g/次,2次/d),连续治疗3个疗程,观察组患者采用DC-CIK生物疗法联合索拉非尼,连续治疗3个疗程.观察并比较2组治疗效果及外周血中T淋巴细胞亚群、不良反应.结果 (1)DC-CIK细胞1~3 d增殖较慢,4~6 d增殖较快,且比单纯CIK细胞的增殖速度更快.(2)治疗后观察组患者肿瘤总缓解率(48.71%)显著高于对照组(23.08%)(P<0.05).(3)治疗后观察组患者外周血中CD+3、CD+4、CD+8、CD+4/CD+8、CD+16、CD+56细胞的比例显著高于对照组(P<0.05).(4)2组患者均出现发热、皮疹、恶心呕吐等不良反应,差异无统计学意义(P>0.05).结论 采用DC-CIK生物疗法联合索拉非尼治疗原发性肝癌患者,能提高患者的免疫功能,且疗效显著,值得临床推广应用.     

苯磺酸氨氯地平对原发性高血压患者血压晨峰现象的影响

目的 探讨苯磺酸氨氯地平对原发性高血压患者血压晨峰影响。方法 将104例出现血压晨峰现象的原发性高血压病患者随机分成苯磺酸氨氯地平组和非洛地平组,每组52例。非洛地平组给予非洛地平5mg,2次/d,苯磺酸氨氯地平组给予苯磺酸氨氯地平5mg,1次/d。观察两组血压晨峰数值变化情况。结果 治疗前两组患者均具有血压晨峰现象,治疗后苯磺酸氨氯地平组血压晨峰现象的控制率高于非洛地平组,差异有统计学意义（P〈0.05）。结论 苯磺酸氨氯地平与非洛地平均可有效控制血压晨峰现象,但苯磺酸氨氯地平控制血压晨峰的疗效优于非洛地平。     

透明质酸钠关节腔内注射致过敏反应

1例71岁男性患者因膝关节骨性关节炎入院给予透明质酸钠20 mg右膝关节腔内注射。第1次治疗后患者无明显不适。6 d后,第2次膝关节腔内注射透明质酸钠20 mg。注射后约5 h,患者突然出现寒战、心慌、呼吸困难,血压96/60 mm Hg(1 mmHg=0.133 kPa)。立即给予吸氧等对症治疗,1 h后症状逐渐缓解,血压105/70 mm Hg。住院期间未再应用该药,未再发生上述不良反应。共住院2周出院。     

Malignant hypertension with irreversible renal failure due to oral contraceptives.

The case report of a 27-year-old woman who had been normotensive before her 1st pregnancy 6 years earlier is presented. At 2 months postdelivery she began taking estro-progesterone. She was given Enidrel R (norethynodrel 4.925 mg, mestranol .075 mg) for 18 months and then Ovariostat (lynestrenol 2.5 mg, mestranol .075 mg). Her blood pressure was not recorded until 2 years later when it was 180 mm Hg systolic. Contraceptive therapy was then stopped. A month later pregnancy occurred. At that time her blood pressure was 120 mm Hg. The delivery was normal. 4 months later she began taking Ovariostat again. Headaches soon developed and her blood pressure was found to be 270/150 mm Hg. On admission to the hospital 3 weeks later her blood pressure was 250/100 mm Hg. Renal failure was present. Creatinine clearance was 12 ml/minute. No cause for this hypertension was found. 1 month later hypertension was 210/160 mm Ha. Retinal hemorrhaging had lessened but azotemia persisted. Heart failure and oliguria followed. Dialysis was done weekly. A bilateral nephrectomy was done. Microscopic study of renal tissue showed malignant nephroangiosclerosis. After 10 days her blood pressure was 150/100 mm Hg. Her general condition improved. A salt-free diet was prescribed. Blood pressure subsided to 140/80 mm Hg before dialysis. A renal graft was done and 10 months later blood pressure was normal. These hypertensions are usually benign and subside when the contraceptive therapy is discontinued. When estrogen-progesterones are prescribed, blood pressures should be recorded frequently and therapy stopped if hypertension arises.     

曲妥珠单抗引起过敏样反应

1例52岁女性患者,因乳腺癌术后辅助化疗给予曲妥珠单抗220mg加入0.9%氯化钠注射液250ml静脉滴注,滴速为50滴/min。输入约30min时,患者出现寒战、胸闷、口唇发麻、呼吸困难,心率165次/min,血压199/99mm Hg。立即停止输液,行对症治疗。50min后上述症状消失,心率及血压恢复正常。21d后再次化疗,曲妥珠单抗110mg加入0.9%氯化钠注射液250ml静脉滴注,滴速30滴/min。5min后,患者再次出现过敏样症状。停药10min后症状消失。     

鲑鱼降钙素致腹部绞痛与心律失常2例

2名老年女性患者给予鲑鱼降钙素注射液治疗时出现腹部绞痛、腹泻、心律失常等不良反应。第1例为67岁女性,因腰椎间盘退行性病变、骨质疏松入院,给予葡萄糖酸钙1g,2次/d口服,并在皮肤试验呈阴性后给予肌内注射鲑鱼降钙素50IU,1次/d。注射后30min出现腹部绞痛,排黄色糊状便1次;2h出现心悸,心电图检查示:心律不齐、阵发性室性心动过速、偶发房性期前收缩,持续约1h后症状消失。连续注射3d,症状加重并出现双眼睑水肿,遂改为每周注射1次,注射2周后仍有上述症状,即停药,5d后症状缓解,再行心电图检查正常。第2例为65岁女性,以"腰椎间盘脱出、双膝关节退行性变"入院。实验室检查:血钙2.02mmol/L。于皮试阴性后,给予肌内注射鲑鱼降钙素50IU。注射后2h出现腹部绞痛、尿频、尿急、腹泻。心电图示:窦性心动过速。6h后症状自行缓解,未进行第2次注射。     

利多卡因口腔局部麻醉致过敏性休克继发急性左心衰竭

1名43岁女性患者接受2%利多卡因3ml口腔局部麻醉,2min后出现头晕、恶心,继而意识丧失,面色苍白,出汗,呼吸急促,口唇发绀,心率145次/min,血压测未及,经肾上腺素、多巴胺、氟美松及快速补液处理后,患者意识恢复,血压、心率正常。然而2h后患者又出现呼吸困难、端坐呼吸、咯粉红色泡沫样痰,吸氧5L/min时指端SpO2降至0.78,BP升至180/110mmHg,HR140次/min,双肺内可闻及广泛的水泡音和哮鸣音,经给予硝普钠、毛花苷丙和呋塞米治疗后,上述症状消失。     

苦丹丸致肝损害

1例46岁女性,因银屑病关节炎自行服用苦丹丸2丸(6 g),3次/d。用药5 d后出现乏力、腹胀,继续服药症状加重,19d后停药。停药第2天患者皮肤、巩膜明显黄染,收入院。血生化检查:丙氨酸转氨酶1384 U/L,天冬氨酸转氨酶1311 U/L,总胆红素91.4μmol/L,直接胆红素53.5μmol/L,间接胆红素37.9μmol/L。诊断为药物性肝损害,给予甘草酸二铵、还原型谷胱甘肽等治疗。20 d后患者症状消失,肝功能基本恢复正常,遂出院。     

九华痔疮栓引起过敏性休克

1例28岁混合痔和肛裂女性患者用九华痔疮栓治疗。用药约3min后，患者出现颜面红痒发麻、口唇肿胀、恶心、呕吐、腹泻，头晕及意识模糊。患者BP为60／40mmHg，HR 120次／min。经对症、支持治疗后，患者意识恢复，症状缓解。     

头孢孟多致多器官功能衰竭

1例73岁女性患者因结肠镜息肉切除术后预防感染,静脉滴注头孢孟多2．0g。输注完毕约2h,患者出现剧烈腹痛,给予解痉治疗未缓解;40min后出现血白细胞减少（1．0×109／L）,予丙帕他莫止痛,疼痛缓解。次日11：00患者突然出现血压降低[最低至80／50mmHg（1mmHg=0．133kPa）]、心率加快,立即给予升压和补充血容量治疗。12：30再次静脉滴注头孢孟多2．0g,输注完毕后,患者出现休克,血压70／30mmHg,并逐渐出现急性肾损伤、急性肺水肿,左心功能减低、肝损伤、血细胞减少、凝血功能障碍和弥散性血管内凝血。转入重症监护病房,经2周抢救治疗,患者病情逐渐好转。2个月后,除。肾功能异常（血清肌酐165I．μmol／L,尿素9．1mmol／L）外,肝功能、凝血功能及血细胞等各项指标均恢复正常。     

Response to Sorafenib After Sunitinib-Induced Acute Heart Failure in a Patient with Metastatic Renal Cell Carcinoma: Case Report and Review of the Literature

Cardiotoxicity is an emerging concern with a new class of drugs known as targeted agents, which include trastuzumab and sunitinib. Sunitinib is a small molecule that inhibits multiple tyrosine kinase receptors. This drug was approved by the United States Food and Drug Administration in 2006 for the treatment of clear cell metastatic renal cell carcinoma and advanced gastrointestinal stromal tumors. We describe a 65-year-old woman who was treated with sunitinib for metastatic clear cell renal cell carcinoma. After 5 months of therapy, she developed acute heart failure requiring hospitalization; sunitinib was immediately discontinued. The patient had classic symptoms of heart failure, including pleural effusion. An echocardiogram revealed a left ventricular ejection fraction of 30%. She received standard treatment for heart failure, including a β-blocker, an angiotensin-converting enzyme inhibitor, and diuretics. Within 1 month, the patient's symptoms resolved, and subsequent cardiac evaluation showed that her left ventricular ejection fraction returned to normal. According to the Common Terminology Criteria for Adverse Events developed by the National Cancer Institute, her cardiac event associated with sunitinib was defined as grade III toxicity. One month later, sorafenib, another tyrosine kinase inhibitor, was started with the aim of continuing her previous response to sunitinib. After 7 months of sorafenib therapy, the patient had no evidence of heart failure, and her condition was responding to treatment. Clinicians should be aware that sunitinib-induced heart failure occurs occultly and that many—but not all—cases resolve with discontinuation of the drug. Use of sorafenib after sunitinib-induced heart failure appears to be safe and effective, which suggests that cardiotoxicity is not a general class effect of the tyrosine kinase inhibitors.     

复方甘草酸苷注射液引起假性醛固酮增多症

1例38岁女性患者,因服用酮康唑导致药物性肝损害入院。入院后给予复方甘草酸苷注射液100ml（含甘草酸苷200mg）加入5%葡萄糖注射液250ml静脉滴注,共2周。随后,患者出现全身水肿,双下肢明显,血压波动在136～140/90～100mmHg,血钾2.56mmol/L。停用该药,给予螺内酯片及氯化钾控释片治疗,7d后症状好转。入院26d痊愈出院,随访2周无不适。