大剂量甲氨喋呤在儿童急性淋巴细胞白血病中应用观察

目的：观察大剂量甲氨喋呤化疗在儿童急性淋巴细胞白血病中的应用，了解其不良反应。方法：缓解期急性淋巴细胞白血病患儿17例；高危13例，标危4例。累计应用100例次大剂量甲氨喋吟治疗，观察并总结其不良反应发生的种类、发生率、相应处理措施及转归。结果：胃肠道反应、肝功能损害、口腔溃疡、骨髓轻度抑制是大剂量甲氨喋岭常见的不良反应，黏膜炎和重度骨髓抑制形成恶性循环，严重时可致死。结论：充分水化碱化，适宜四氢叶酸钙解救，密切观察病情变化随时处理及必要的心理护理是保证大剂量甲氨喋岭方案顺利进行的关键因素。

Observation of the adverse effects of high-dose methotrexate on acute lymphoblastic leukemia in children

Objective To evaluate the adverse effects of high-dose methotrexate on acute lymphoblastic leukemia in children. Methods Seventeen children with acute lymphoblastic leukemia in remission, 13 with high risk, 4 standard risk, were observed the types, incidence, treatment and turnover of adverse effects in total 100 infusions of high-dose methotrexate. Results Gastrointestinal reaction, hepatic damage, dental ulcer, slight depression of bone marrow were the common adverse effects of high-dose methotrexate, the infernal circle of mucositis and serious depression of bone marrow was fatal. Conclusion Adequate hydration and alkalihization, correct calcium folinate rescue and timely treatment of complication play the key roles in hlgh-dose methotrexate.