培美曲塞化疗致腹泻、多器官功能衰竭死亡

1例64岁恶性胸膜间皮瘤女性患者，接受培美曲塞0．5g静脉滴注1次行第2次化疗。化疗后2～6d，患者出现食欲下降、恶心、呕吐、腹泻，服用盐酸小檗碱后未缓解。入院后查体：T38．5℃，HR130次／min，BP75／40mmHg。心电图示：频发房性期前收缩，偶见室性期前收缩。血常规：WBC2．4×10^9／L，RBC2．14×10^12／L，Hb65g/L，PLT13×10^9／L。便常规：RBC0～2个／HP，WBC4～7个／HP，隐血试验阳性。血生化：LDH 204U／L，TBil 39．4μmol／L，BUN24．0mmol／L，Cr239μmol／L。凝血酶原时间（PT）19．5s，凝血酶原活动度（PTA）41％，部分凝血活酶时间（APTT）58．7s。血气分析：pH6．91，PCO2 37mmHg。立即气管插管机械通气，给予补充白蛋白、血浆，抗感染、抗休克、抗心律失常等治疗。入院第2天，患者病情进行性加重，出现深昏迷，少尿，大量腹水，血压难以维持。给予持续血液滤过，加用重组人粒细胞集落刺激因子（rhG—CSF）。第3天，患者因多器官功能衰竭死亡。

Death from diarrhea and multiorgan failure related to chemotherapy with pemetrexed

A 64-year-old woman with malignant pleural mesothelioma received the second injection of IV pemetrexed 0.5 g under chemotherapy. Two to six days after the therapy, she developed anorexia, nausea, vomiting, and diarrhea. The symptoms were not relieved after she took berberine hydrochloride. On admission, her body temperature was 38.5 ℃, her heart rate was 130 beats/min, and her blood pressure was 75/40 mmHg. An ECG showed frequent atrial premature beats and occasional ventricualr premature beats. A blood routine test showed a WBC count of 2.4× 10^9/L, a RBC count of 2.14 × 10^2/L, a Hb level of 65 g/L, and a PLT count of 13 × 10^9/L. A stool analysis detected 0-2 RBCs per high-power field and 4-7 WBCs per high-power field, and an occult blood test was positive. Blood biochemistry examination revealed the following values： LDH 204 U/L, TBil 39.4 μmol/L, BUN 24.0 mmol/L, and Cr 239 μmol/L. Her prothrombin time （PT） was 19.5 seconds, her prothrombin activity （PTA） was 41%, and her activated partial thromboplastin time （AtrIT） was 58.7 seconds. Arterial blood gas analysis revealed a pH of 6.91 and a paCO2 of 37 mmHg. She received tracheal intubation and mechanical ventilation immediately. Supplement of albumin and plasma, and anti-infective therapy, anti-shock, and anti-arrhythmia treatment were given. On day 2 after admission, the patient＇s condition worsened. She presented with deep coma, oliguria, and a great quantity of ascites. It was hard to maintain adequate blood pressure. Sustained hemofihration and rhG-CSF were administered. On day 3, the patient died of muhiorgan failure.