米托蒽醌的外渗与组织坏死

通常认为米托蒽醌是非糜烂性毒剂。实验动物皮内给药并不引起典型的外渗伤害或坏死，对人类静脉注射也未见外渗或坏死。然而，仍有米托蒽醌外渗造成局部反应和组织坏死的报道。现报道一例由米托蒽醌引起的组织损伤和坏死的重度并发症。患者为66岁的老年妇女，单用米托蒽醌19毫克作为转移性乳腺癌的三线治疗方法。经静脉导管将足量药物置于0．9％氯化钠100毫升溶液中，由腕部小静脉输入。护士发现，在没有加入其他药物的情况下，沿输入静脉途径有回流现象和导管进入部位皮肤变兰色。护士用0．9％氯化钠10毫升溶液冲洗导管，并取下导管。当时…     

诺维本外渗及静脉炎的防治

诺维本 (长春瑞宾 ,NVB) ,异长春花碱 ,可阻断G2 与M期细胞的有丝分裂周期 ,是细胞周期特异性抗肿瘤药物。静脉给药后分布广泛而持久 ,在临床上主要用于治疗非小细胞肺癌、乳腺癌、淋巴瘤等。主要不良反应有骨髓抑制、神经毒性、胃肠道反应、支气管肺毒性、脱发等。该药对血管皮肤刺激性强 ,属于发泡类的化疗药 ,在静脉注射时易出现药物外渗 ,可引起严重反应、静脉炎甚至组织坏死。本文通过观察NVB 2例外渗 ,4例静脉炎的临床表现、处理过程、提出对给药方法的改进措施。1　临床资料1.1　一般资料　 2 0 0 2年在我院肿瘤内科住院患者中 ,…     

白血病患者化疗药物外渗的紧急综合处理（附15例报告）

白血病是严重威胁人类健康的疾病，目前大剂量联合化疗仍是降低复发率，提高长期无病生存率，改善生存质量的重要治疗方法。由于反复静脉穿刺输液，化疗药物易外渗。一旦化疗药物外渗容易引起局部组织坏死。我科自2002年以来采取一系列紧急综合措施处理化疗药物外渗15例，无组织坏死发生，取得较为满意效果，现报道如下。     

白血病患者化疗药物外渗的紧急综合处理(附15例报告)

白血病是严重威胁人类健康的疾病,目前大剂量联合化疗仍是降低复发率,提高长期无病生存率,改善生存质量的重要治疗方法。由于反复静脉穿刺输液,化疗药物易外渗。一旦化疗药物外渗容易引起局部组织坏死。我科自2002年以来采取一系列紧急综合措施处理化疗药物外渗15例,无组织坏死发生,取得较为满意效果,现报道如下。2002年6月—2005年1月,我科有15例白血病患者发生化疗药物外渗,其中,长春新碱6例(1例为操作失误,注入肌肉),阿霉素4例,柔红霉素2例,米托蒽醌2例,环磷酰胺1例,经处理后均于1周内恢复正常,无一例出现组织坏死。药物处渗后的处理:1)…     

肿瘤患者静脉化疗安全用药的体会

化疗药物可引起全身及局部毒副反应,其中局部毒副反应是指药物注射部位周围组织产生的反应,包括静脉炎、静脉变色、红斑、疼痛或药物外渗引起的局部组织坏死[1]。现在由于采用了大剂量静脉化疗方案或使用发疱性、刺激性化疗药物,易导致静脉炎和化疗药物外渗损伤,增加了患者的痛苦,影响了护理质量。现就这方面的护理工作体会报道如下。     

30例化疗药物外渗的原因分析及对策

化疗药物是一种强刺激药物，需静脉给药，在给药过程中如不慎漏出血管外，可导致局部皮肤及软组织非特异性炎症，不及时处理局部组织坏死，给病人增加痛苦，降低其生活质量。化疗药物外渗的因素很多，我们对2003年3月至9月的30例化疗药物外渗，从护士、病人两方面分析其原因并观察其发生的时间，从而制定相应的护理对策。     

化疗药物外渗的预防

化疗是治疗恶性肿瘤的重要手段之一,静脉给药是化疗药物的主要给药途径。化疗药物外渗的发生率国内报道是0.1%-6.0%,国外报道是5.0%[1]。化疗药物外渗可引起局部肿胀、疼痛,     

1例长春瑞滨外渗致皮下组织严重反应的护理

长春瑞滨是治疗非小细胞肺癌的有效药物之一,但其刺激性强,外渗后若处理不及时可能引起皮下组织坏死.2005年4月我院成功地治愈1例因长春瑞滨外渗于皮下组织所致组织严重炎性反应的患者.现将护理体会报告如下.     

粒细胞集落刺激因子治愈化学性皮肤坏死1例

化疗药物渗漏到皮下组织，轻者可引起局部红肿、疼痛，严重可损伤神经、肌腱，甚至造成皮肤组织坏死、肢体功能障碍。我们采用以粒细胞集落刺激因子（G-CSF）为主的综合治疗治愈表阿霉素外渗导致皮肤坏死1例，现报告如下。     

化疗药物外渗的预防

化疗是治疗恶性肿瘤的重要手段之一,静脉给药是化疗药物的主要给药途径。化疗药物外渗的发生率国内报道是0.1%~6.0%,国外报道是5.0%[1]。化疗药物外渗可引起局部肿胀、疼痛,严重时可导致局部     

Demonstration of cutaneous doxorubicin extravasation by rhodamine-filtered fluorescence microscopy

Accidental extravasation of the widely used antineoplastic anthracycline doxorubicin (adriamycin) is capable of causing serious and on-going skin and soft tissue necrosis leading to loss of limb function. The only effective cure has been the complete surgical excision of drug-contaminated tissue. Surgical excisions preparatory to skin grafting have often underestimated the extent of drug infiltration into tissue. Using an experimental technique utilizing the drug's natural property of red fluorescence, we were able to effect complete surgical excision by rhodamine fluorescence microscopy in frozen sections of resected skin.     

Conservative approach to the treatment of chemotherapy-induced extravasation

One of the local complications of certain chemotherapeutic agents is tissue necrosis resulting from extravasation. The purpose of this study was to evaluate the effectiveness of a conservative approach to treatment in order to minimize necrosis and the need for reconstructive surgery. Fifty-three patients entered this study. Twenty-one had old lesions while 32 had recent extravasations. Drugs responsible for the extravasations were doxorubicin, epirubicin, vinblastine, mitoxantrone, and mitomycin C. The basis of treatment was betamethasone ointment, which was applied to the lesion with a tight elastic bandage and was replaced every 12 hours for the first 2 days and then every 24 hours until complete healing. For old lesions a keratolytic ointment was initially applied, whereas in the new lesions multiple subcutaneous injections with hydrocortisone solution preceded the application of betamethasone ointment. None of our patients developed tissue necrosis and sloughing that necessitated surgery. All lesions healed in patients. Healing time varied with the different drugs used and was proportional to the extension of extravasation and to the time when therapy was begun. We conclude that the application of conservative measures in extravasated areas from chemotherapy may avoid tissue necrosis and reconstructive surgery.     

Chirurgische Therapieoptionen nach Extravasaten systemischer Chemotherapie

Introduction

Extravasal application of chemotherapeutic agents may cause necrosis of the surrounding tissue. Often tendons, nerves and muscles are destroyed. In some cases, a surgical excision with additional coverage is indicated.

Surgical treatment

We report on 29 patients with necrosis after extravasation. In most cases, the lesion was localized to the hand or distal forearm, but the cubital fossa and thorax were also affected. Excision of the infiltrated tissue was performed and covered with local or free flaps, a split skin graft or primary closure.

Complications

Stable coverage was achieved in all cases. Patients with immunosuppression or comorbidity sometimes had wound healing difficulties. There were no important complications, such as flap necrosis, septicemia or infection.

Discussion

Chemotherapeutic extravasation is an important oncological complication that may cause permanent functional disability to the anatomical region involved. A variety of free and local flaps with tolerable donor morbidity can be used for coverage. Conservative treatment is often followed by a high rate of complications. Early radical debridement and coverage with an adequate flap offers a cure.     

Extravasation of Chemotherapy

Extravasation of chemotherapy is a feared complication of anticancer therapy. The accidental leakage of cytostatic agents into the perivascular tissues may have devastating short-term and long-term consequences for patients. In recent years, the increased focus on chemotherapy extravasation has led to the development of international guidelines that have proven useful tools in daily clinical practice. Moreover, the tissue destruction in one of the most dreaded types of extravasation (ie, anthracycline extravasation) now can effectively be prevented with a specific antidote, dexrazoxane.     

Anorexia

In patients with advanced cancer, anorexia, or loss of appetite, is prevalent, distressing, and predictive of a poor prognosis. Patients with cancer who are receiving antineoplastic treatment experience this symptom, as do patients with cancer who are no longer receiving such therapy. Yet palliative options remain limited. The two most frequently used palliative measures employ progestational agents and corticosteroids. Both classes of agents provide only modest clinical benefits. Recent studies suggest promising results with melatonin, blockade of tumor necrosis factor-α, necrosis factor-κ B decoys, adenosine triphosphate, antiemetics, and anti-inflammatory agents. These agents appear promising, but further clinical research is needed before they can be prescribed outside clinical trial settings.     

Zytostatikabedingte Paravasate – ein seltenes Ereignis?

Intravenous drug application is a daily activity in every hospital and medical practice. One of the major challenges for doctors and nurses is obtaining a safe intravenous line in every situation. Unfortunately complications are always possible. One of the most dangerous problems is extravasation of local toxic agents. The frequency of extravasation and the extent of tissue damage are different depending on localisation of the vein and other risk factors, such as restlessness of the patient or lymphedema of the extremity. It is essential to prevent extravasation by minimizing iatrogenic failures and by educating patients prior to application of toxic substances. If extravasation occurs the infusion has to be stopped immediately and general actions as well specific antidotes have to be administered.     

抗肿瘤药物对肾上腺机制影响的研究进展

多种抗肿瘤药物如激素类、化疗、靶向药物和免疫检查点抑制剂在发挥抗癌作用的同时对内分泌腺具有毒性作用,其中对肾上腺的影响逐渐受到临床重视。药物治疗相关的肾上腺功能不全若无法及时诊治,可导致肾上腺危象的发生甚至危及生命。本文将就抗肿瘤药物对肾上腺机制影响进行综述,为临床防治肿瘤患者的肾上腺功能异常提供指导。      

Tissue concentration of systemically administered antineoplastic agents in human brain tumors

The blood–brain-barrier (BBB) limits the penetration of many systemic antineoplastic therapies. Consequently, many agents may be used in clinical studies and clinical practice though they may not achieve therapeutic levels within the tumor. We sought to compile the currently available human data on antineoplastic drug concentrations in brain and tumor tissue according to BBB status. A review of the literature was conducted for human studies providing concentrations of antineoplastic agents in blood and metastatic brain tumors or high-grade gliomas. Studies were considered optimal if they reported simultaneous tissue and blood concentration, multiple sampling times and locations, MRI localization, BBB status at sampling site, tumor histology, and individual subject data. Twenty-Four studies of 19 compounds were included. These examined 18 agents in contrast-enhancing regions of high-grade gliomas, with optimal data for 2. For metastatic brain tumors, adequate data was found for 9 agents. Considerable heterogeneity was found in the measurement value, tumor type, measurement timing, and sampling location within and among studies, limiting the applicability of the results. Tissue to blood ratios ranged from 0.054 for carboplatin to 34 for mitoxantrone in high-grade gliomas, and were lowest for temozolomide (0.118) and etoposide (0.116), and highest for mitoxantrone (32.02) in metastatic tumors. The available data examining the concentration of antineoplastic agents in brain and tumor tissue is sparse and limited by considerable heterogeneity. More studies with careful quantification of antineoplastic agents in brain and tumor tissue is required for the rational development of therapeutic regimens.     

Prevention of cytotoxic drug induced skin ulcers with dimethyl sulfoxide (DMSO) and α-tocopherole

Accidental subcutaneous extravasation of several antineoplastic agents may provoke skin ulcerations for which there has been no simple and effective treatment. Since January 1983 we have treated all patients in our institution sustaining extravasation by a cytotoxic drug with a combination of DMSO and α-Tocopherole. During the first 48 hr after extravasation a mixture of 10% α-Tocopherole acetate and 90% DMSO was topically applied. The bandage was changed every 12 hr. So far eight patients with extravasation of an anthracycline or Mitomycin were treated on this protocol. No skin ulceration, functional or neurovascular impairment occured in any of these patients. The only toxic effect observed by this treatment was a minor skin irritation. The combination of DMSO and α-Tocopherole seems to prevent skin ulceration induced by anthracyclines and Mitomycin.     

Detection of extravasation of antineoplastic drugs by microwave radiometry

Microwave radiometry may be used as a non-invasive technique for subcutaneous thermal sensing. This technique was capable of demonstrating extravasation of small volumes of fluids, including the antineoplastic agent adriamycin, when these fluids were administered at room temperature in dogs. The rate of temperature drop upon extravasation was proportional to the flow rate. It is feasible that microwave radiometry may be useful as an alarm system to reduce serious complications which often accompany the extravasation of antineoplastic drugs.