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目的:探讨大剂量甲氨蝶呤化疗方案治疗儿童急性淋巴细胞白血病导致血药浓度异常升高的影响因素,为临床合理使用提供帮助。方法:通过医院电子病历系统,查阅患者各项诊疗、检查及用药资料,根据相关指南和诊疗规范对1例大剂量甲氨蝶呤治疗儿童急性淋巴细胞白血病血药浓度异常升高的用药情况进行分析。结果:该患者甲氨蝶呤血药浓度超过正常值10天,可能与化疗方案的选择、亚叶酸钙的解救、水化碱化、合并用药等因素相关。结论:临床医生应关注影响甲氨蝶呤血药浓度的多种因素,提高疗效,减少不良反应的发生;临床药师有必要参与患者治疗。
Objective: To investigate the influencing factors of high dose methotrexate chemotherapy regimen in children with acute lymphoblastic leukemia leading to abnormally elevated plasma concentration, which may be helpful for clinical rational use. Methods: Through the hospital electronic medical record system, access to the patient’s diagnosis and treatment, examination and medication information, according to the relevant guidelines and treatment guidelines for 1 case of high-dose methotrexate treatment of children with acute lymphoblastic leukemia in patients with abnormally elevated plasma concentrations of medication analysis. Results: The concentration of methotrexate in this patient exceeded the normal value for 10 days, which may be related to the choice of chemotherapy regimen, the rescue of leucovorin, hydration and alkalization, combined medication and other factors. Conclusion: Clinicians should pay attention to many factors that influence the blood concentration of methotrexate to improve the curative effect and reduce the incidence of adverse reactions. It is necessary for clinical pharmacists to participate in the treatment of patients.