贝伐珠单抗联合化疗导致昏迷2例并文献复习

  目的  分析贝伐珠单抗联合化疗后昏迷患者的临床特征、危险因素、治疗转归，提高对贝伐珠单抗联合化疗治疗转移性结直肠癌毒性的认知和预防水平。  方法  报道2例贝伐珠单抗联合化疗后昏迷患者的临床特征及诊治过程，结合国内外文献进行分析。  结果  血压控制不佳是贝伐珠单抗联合化疗后昏迷的危险因素，临床表现为可逆的后部脑白质病变综合症，患者可以无典型的影像学表现，加强血压控制等支持治疗，患者预后良好。  结论  贝伐珠单抗联合化疗导致患者昏迷并不少见，因此需慎用于有高血压病史的患者，治疗期间密切监测血压变化，经过提高警惕和及时处理，预防昏迷出现。同时在出现以后，通过积极治疗，昏迷也是可逆的并发症。 

Report and literature review of two cases of coma induced by bevacizumab combined with chemotherapy

  Objective  The clinical features, risk factors, and outcomes of coma were analyzed in patients treated with bevacizumab combined with chemotherapy This study also aims to increase the awareness on the toxicity of this regimen.  Methods  Two cases of coma induced by bevacizumab combined with chemotherapy were reported. Diagnosis, treatment, and relevant literature were reviewed and discussed.  Results  Inadequate blood pressure (BP) control was one of the risk factors leading to coma in patients treated with this therapy. The clinical feature of these patients was reversible posterior leukoencephalopathy syndrome (RLPS). Imaging results showed no typical finding. Reinforced supportive treatment including intensive BP control showed satisfactory outcomes.  Conclusion  Coma is common in patients treated with bevacizumab combined with chemotherapy. This regimen should be used cautiously in patients with a history of hypertension. BP should be monitored closely and managed promptly during the combination therapy to prevent coma. RLPS-related coma is reversible after appropriate treatment.