查看更多>>摘要：1例30岁女性急性髓系白血病患者接受阿糖胞苷（200 mg/m2静脉滴注、1次/d，共7 d）联合伊达比星（10 mg/m2静脉滴注、1次/d，共3 d）方案（IA方案）化疗。治疗第5天，患者出现呼吸困难，呼吸35次/min，指脉血氧饱和度92%。给予高流量吸氧等治疗，当日夜间患者呼吸困难加重，心率160次/min，呼吸50次/min，指脉血氧饱和度50%；次日胸部CT示双肺肺泡性肺水肿合并间质性肺水肿。考虑为阿糖胞苷所致非心源性肺水肿。停用化疗药物，给予糖皮质激素、利尿、肺保护性通气、俯卧位通气等治疗，但患者相关症状未改善，10 d后出现继发性气胸并因呼吸衰竭死亡。 A 30-year-old female patient with acute myeloid leukemia received chemotherapy with IA regimen of cytarabine (200 mg/m2 once daily by IV infusion， 7 days in total) and idarubicin (10 mg/m2 once daily by IV infusion， 3 days in total)。 On the 5th day of treatments， the patient developed dyspnea， with breath rate 35 times/min and finger pulse oxygen saturation 92%。 She was treated with high flow oxygen inhalation， but the patient′s dyspnea was aggravated at night， with heart rate 160 times/min and breath rate 50 times/min the finger pulse oxygen saturation decreased to 50%。 Lung CT examination next day showed bilateral alveolar pulmonary edema with interstitial pulmonary edema， which was considered as non- cardiogenic pulmonary edema caused by cytarabine。 Chemotherapy drugs were stopped and glucocorticoids， diuresis， lung protective ventilation， prone position ventilation， and other treatments were given， but the patient′s relevant symptoms were not improved。 Ten days later， the patient developed secondary pneumothorax and died due to respiratory failure。
查看更多>>摘要：1例87岁女性阿尔茨海默病患者服用多奈哌齐（5 mg、1次/d）8年后，因病情进展加服美金刚（10 mg、1次/d）。3个月后，患者突发昏迷，呼之不应，呼吸急促，喘憋；双眼瞳孔针尖样改变，血压190/100 mmHg（1 mmHg=0。133 kPa），心率56次/min，格拉斯哥昏迷评分（GCS）为E1V1M1。考虑患者为多奈哌齐和美金刚联用导致药物蓄积中毒（美金刚血浓度215 mg/L，警戒值：30 mg/L；多奈哌齐血浓度33 mg/L，警戒值：20 mg/L）。停用2药，给予补液水化、降压、醒脑等对症支持治疗。停药第3天，患者意识一过性转为嗜睡，GCS评分为E2V2M2；停药第7天，患者意识转清，可简单对答，GCS评分为E4V4M4，血压126/67 mmHg，瞳孔大小恢复正常。 An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition。 Three months later， the patient suddenly fell into a coma and did not respond to call， acompanied by shortness of breath and wheezing。 The patient had needle like changes in the pupils of both eyes， with blood pressure 190/100 mmHg and heart rate 56 beats per minute。 The Glasgow Coma Scale (GCS) was E1V1M1。 It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L， warning value: 30 mg/L blood concentration of donepezil 33 mg/L， warning value: 20 mg/L)。 The 2 drugs were stopped， and symptomatic and supportive treatments such as fluid hydration， blood pressure reduction， and brain awakening were given。 On the 3th day after drug discontinuation， the patient′s consciousness temporarily shifted to drowsiness， and her GCS was E1V1M1 on the 7th day after drug discontinuation， the patient′s consciousness became clear and she was able to answer simple questions， with GCS E4V4M4， blood pressure 126/67 mmHg， and normal pupil size。
查看更多>>摘要：1例68岁女性浸润性尿路上皮癌患者术后接受免疫治疗（维迪西妥单抗120 mg+特瑞普利单抗240 mg静脉滴注、第1天，14 d为1个周期）。首次用药后19 d，患者诉腰部肌肉酸痛，实验室检查示肌酸激酶（CK）1 079 U/L，CK-MB 33 U/L。暂停第2个周期免疫治疗，并予泼尼松20 mg口服、1次/d。5 d后，患者出现胸闷，实验室检查示CK 3 366 U/L，CK-MB 91 U/L，乳酸脱氢酶518 U/L，肌红蛋白1 282 μg/L，高敏肌钙蛋白T 0。068 μg/L，氨基末端脑利钠肽前体148 ng/L。结合心脏彩色多普勒超声检查结果，考虑为维迪西妥单抗和特瑞普利单抗联用所致心肌炎，将泼尼松换为甲泼尼龙160 mg静脉滴注、1次/d。患者上述实验室检查指标逐渐下降，但心电图检查示异位心律，给予胺碘酮等治疗。甲泼尼龙静脉滴注11 d后，改为甲泼尼龙片20 mg口服、1次/d（逐渐减量并停用）。停用激素后4 d复查，患者实验室指标和心电图未见异常。 A 68-year-old female patient with invasive urothelial carcinoma received immune treatments with disitamab vedotin 120 mg and toripalimab 240 mg intravenously on the first day， and 14 days was a cycle。 Nineteen days after the first medication， the patient complained of lower back muscle soreness。 Laboratory tests showed creatine kinase (CK) 1 079 U/L and CK-MB 33 U/L。 The 2nd cycle of immunotherapy was suspended and prednisone 20 mg orally once daily was given。 Five days later， the patient felt chest tightness， and laboratory tests showed CK 3 366 U/L， CK-MB 91 U/L， lactic dehydrogenase 518 U/L， myoglobin 1 282 μg/L， high-sensitivity troponin T 0。068 μg/L， and N-terminal pro-brain natriuretic peptide 148 ng/L。 Myocarditis caused by the combination of disitamab vedotin and toripalimab was considered， referring to the cardiac color Doppler ultrasound examination。 Prednisone was switched to IV infusion of methylprednisolone 160 mg once daily。 The above laboratory test indicators gradually decreased， but the electrocardiogram showed ectopic heart rhythm。 Amiodarone was added。 After 11 days of methylprednisolone treatment by IV infusion， methylprednisolone 20 mg orally once daily was given， which was gradually reduced and discontinued finally。 Four days later， the patient′s laboratory indicators and electrocardiogram showed no abnormalities in the re-examination。
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