大剂量甲氨蝶呤治疗急性淋巴细胞白血病的观察及护理

目的探讨大剂量甲氨蝶呤（HDMTX）在急性淋巴细胞白血病（ALL）治疗中的疗效、不良反应及护理措施。方法对17例缓解期ALL患者进行23例次HDMTX（3．0g／m^2）连续24h静脉输注，同时给予三联鞘内注射。于第36h甲酰四氢叶酸钙（CF）解救，观察其不良反应并及时对症护理。结果全部患者均能耐受治疗，达持续完全缓解（CCR）。不良反应主要表现为恶心呕吐、口腔黏膜炎、中性粒细胞减少和一过性转氨酶升高等，经对症护理后，均于2周内恢复正常。结论HDMTX治疗ALL是一种安全可行的方法。其中化疗是根本，护理是关键，解救是契机。

Observation and Nursing Care for Patients in High-dose Methotrexate Treatment for Acute Lymphocytic Leukemia

Objective To explore the effect and adverse reaction of high-dose methotrexate in the treatment for patients with acute lymphocytic leukemia(ALL) and the nursing interventions.Methods Seventeen cases of ALL in the stage of remission were given high-dose of methotrexate polyglutamate(MTX) intravenous drip for 24 h 23 times in combination with sheath injection of MTX,cytarabine and dexamethasone.Relief was done by citrovorum factor(CF) after 36 hours.The adverse effects were observed and proper nursing interventions were adopted in time.Results All the patients showed the tolerance for the treatment and reached continuously complete remission(CCR).The manifestations of the adverse effect included vomiting,oral mucosal inflammation,reduction of neutral granulocyte and temporary increase of transaminase.All the adverse reactions disappeared after proper nursing interventions in 2 weeks.Conclusion The high-dose methotrexate treatment for ALL is effective and safe.The chemotherapy is essential;nursing care is the key;and relief is the turning point.