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目的分析奥沙利铂药物不良反应(ADR)的临床特点和防范策略,为临床合理用药提供依据。方法 2011年1月至2016年12月在本院用奥沙利铂治疗后发生的ADR病例共78例。收集所有病例的临床资料并对其用药后ADR发生时间、化疗方案及治疗周期、发生ADR时奥沙利铂的累积剂量、临床表现、严重程度及应对策略进行归纳分析。结果患者主要涉及结直肠癌、胃癌、宫颈癌、卵巢癌及其他癌症,全部用含奥沙利铂化疗方案。发生ADR的化疗方案有紫杉醇+奥沙利铂(TP方案)、多西他赛+奥沙利铂(DP方案)、奥沙利铂+卡培他滨(XELOX方案)、奥沙利铂+亚叶酸钙+氟尿嘧啶(m FOLFOX6方案)、mFOLFOX6+贝伐单抗方案、在mFOLFOX6方案的基础上加大奥沙利铂剂量的FOLFOX7方案、氟尿嘧啶+奥沙利铂(FP方案)和替吉奥联合奥沙利铂方案,均为含氟或紫杉类化疗方案。其中,mFOLFOX6方案和TP方案发生ADR的比例较高,分别是43.59%和30.77%。奥沙利铂的ADR常发生于用药后的5~30min(53.85%),一般均会在24 h内发生。临床表现以皮肤及其附件损害(36.05%)、呼吸系统损害(27.21%)最为常见。结论奥沙利铂联合含氟或紫杉类化疗方案易发生ADR;用奥沙利铂24 h内、特别是用药的前30 min应密切关注其ADR,发生3~4级ADR者,建议停用奥沙利铂。
Objective To analyze the clinical features and preventive strategies of oxaliplatin drug adverse reactions (ADRs) and provide the basis for clinical rational drug use. Methods A total of 78 ADR cases occurred after oxaliplatin treatment in our hospital from January 2011 to December 2016. The clinical data of all the cases were collected and the ADR occurrence time, chemotherapy regimen and treatment cycle, the cumulative dose of oxaliplatin, clinical manifestations, severity and coping strategies were summarized after ADR. Results Patients mainly involved in colorectal cancer, gastric cancer, cervical cancer, ovarian cancer and other cancers, all with oxaliplatin chemotherapy. Chemotherapy regimens for ADR include paclitaxel + oxaliplatin (TP regimen), docetaxel + oxaliplatin (DP regimen), oxaliplatin + capecitabine (XELOX regimen), oxaliplatin + Leucovorin + fluorouracil (m FOLFOX6 regimen), mFOLFOX6 + bevacizumab regimen, the FOLFOX7 regimen that augmented oxaliplatin on the basis of mFOLFOX6 regimen, the combination of fluorouracil plus oxaliplatin (FP regimen) Saliva platinum program, are fluoride or taxane chemotherapy. Among them, mFOLFOX6 regimen and TP regimen ADR occurred in a higher proportion, respectively 43.59% and 30.77%. Oxaliplatin ADR often occurs after treatment of 5 ~ 30min (53.85%), generally occur within 24 h. Clinical manifestations of the skin and its accessories damage (36.05%), respiratory system damage (27.21%) is the most common. Conclusion Oxaliplatin combined with chemotherapy regimens containing fluoride or taxane is prone to ADR; within 24 h with oxaliplatin, especially in the first 30 minutes of treatment should pay close attention to its ADR, occurred in grade 3-4 ADR, it is recommended to stop With oxaliplatin.