误行鞘内注射长春新碱事件病例报告的系统评价:长春新碱

误行鞘内注射长春新碱事件病例报告的系统评价

【关键词】 长春新碱;
注射，脊髓;
系统评价 evaluation on case reports of inadvertent intrathecal vincristine administration liu hui  hui, xu chang, ma hui  lai, zeng guang. epidemiological office, chinese center for disease control and prevention, beijing 100050, china 【abstract】 objective to evaluate the reasons for intrathecal administration of vincristine, the characteristics of patients with nerve damage, and the effective rescue measures and outcome prognosis. methods electronic literature databases, english and chinese paper documents databases, and network engine were searched for case reports of inadvertent intrathecal injection of vincristine. spss 15.0 was used for statistical analysis. results analysis of 32 cases report showed that the intrathecal injection of vincristine in patients had adverse outcome. of these cases 25 led to death, and survival of cases was associated with lower limb paralysis or quadriplegia. fatalities appeared due to a progressively ascending myeloencephalopathy. early recognition and immediate treatment with csf drainage appeared to be the only intervention that had improved patients" survival. the survival curves of different surgical treatments, whether or not to use folic acid treatment, whether or not to use glutamate treatment, whether or not to use pyridoxinetreatment, was a significant difference. conclusions timely ventriculo  lumbar washout, using folic acid treatment and glutamate treatment appear critical. it is difficult to obtain satisfactory clinical outcome, so the key lies in the implementation of effective preventive measures. 【key words】 vincristine;
injections, spinal;
system evaluation 长春新碱作为抗肿瘤药物用于临床治疗长达40多年，主要用于急性白 血病、恶性淋巴瘤、生殖细胞肿瘤、多发性骨髓瘤等治疗[1]。WWW.133229.COm长春新碱仅用于静脉注射，有严重的神经毒性，是一种严禁用于鞘内注射的药物。

由于缺乏有效的解毒剂，长春新碱误行鞘内注射会造成严重的神经损害，这种损 害常常是致命的。从1968年第1例长春新碱误行注入患者鞘内的病例报告公开发 表以来，陆续有此类文献相继报道[1～11]。为了解误行鞘内注射长春新碱事件 的发生原因、患者神经损害的特点、有效的抢救措施和预后等，有必要对现有的 证据进行系统评价。

1 资料与方法 1.1 纳入标准 纳入所有误行鞘内注射长春新碱的病例个案报道。排 除叙述不清晰以致无法填写笔者所设计的表格、一稿两投重复报道者。