伊立替康致重度迟发性腹泻与骨髓抑制

1例63岁女性结肠癌患者术后采用伊立替康﹢奥沙利铂化疗方案：首日给予伊立替康200 mg﹢奥沙利铂200 mg，第8天给予伊立替康160 mg。化疗第7天患者出现黄色稀便，遂停止化疗，给予保护肠黏膜和止泻药。第8天夜间患者发热（体温38.0℃），外周血白细胞计数0.27×10^9/L，血小板计数117×10^9/L，给予抗感染和升白细胞治疗。第14天再次出现严重水样便，当日血钾2.3 mmol/L、钠126 mmol/L，给予抗感染和纠正电解质紊乱治疗。第16天患者出现持续发热、严重腹胀合并肠麻痹，外周血白细胞计数0.25×10^9/L，血小板计数25×10^9/L，给予亚胺培南/西司他丁钠与奥曲肽。第18天患者血压降至70/40 mmHg（1 mmHg＝0.133 kPa），血氧饱和度测不到，呈昏迷状态。第19天患者经抢救无效死亡。

Severe delayed diarrhea and myelosuppression due to irinotecan

A 63-year-old woman with colon cancer was treated with a chemotherapy consisting of irinotecan and oxaliplatin. She was given irinotecan 200 mg plus oxaliplatin 200 mg by subclavian vein intubation on the first day,and irinotecan 160 mg on the 8th day. On day 7,the patient developed yellow stools. The chemotherapy discontinued. Drugs for protection of intestinal mucosa and antidiarrheal agent were given. On day 8 night,she had a fever. The temperature was 38. 0 ℃. Laboratory tests showed the following values：WBC count 0. 27 × 10^9/L,platelet count 117 × 10^9/L. Anti-infection therapy was given. On day 14,the severe watery stool appeared again,laboratory tests showed following values：serum potassium 2. 26 mmol/L, sodium 126 mmol/L. She received the therapies for infection control and correcting electrolyte imbalance. On day 16, the patient presented persistent fever, severe abdominal distension with intestinal paralysis. Laboratory tests showed following values：WBC count 0. 25 × 10^9/L, platelet count 25 × 10^9/L. She was given imipenem and cilastatin sodium and octreotide. On day 18,her blood pressure decreased to 70/40 mmHg,blood oxygen saturation was not monitored. She was in a coma. On day 19,the patient died despite all rescue measures.