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肿瘤病人化疗不良反应课件

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肿瘤 病人 化疗 不良反应 课件
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Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肿瘤病人化疗不良反应的 观察及处理 江西省肿瘤医院内一科 张春华 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial l一 化疗后不良反应的表 现 l二 化疗后不良反应的预 防 l三 化疗后不良反应的处 理 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 近年来由于新药的不断 涌现 集落刺激因子 淋巴 因子 隔离环境 成分输血 和其他支持治疗的发展 使 得临床医生可以将以往的 常规剂量 提高数倍 以提 高治愈率 但由此也相应带 来了一些严重的不良反应 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 护士必须对病人化疗 后出现的不良反应加强观 察 以便及时处理 从而 减轻病人痛苦 提高病人 的生活质量 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 化疗后不良反应的表现 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 药 物 外 渗 表现 药物注入静脉可 引起化学性静脉炎 漏出或 外渗到血管外可表现局部皮 下或深部组织红肿 疼痛 甚至坏死 溃疡 可经久不 愈 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见的这类药物有发疱 剂如氮芥 长春瑞滨 诺维 苯 蒽环类如阿霉素及长 春碱类等 刺激剂常见有依 托泊甙 达卡巴嗪等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 预防 静注应选择前 臂近心侧静脉穿刺 避免 手背及关节附近部位 证 实静脉穿刺成功及输液通 畅无外渗后 方可静脉冲 入或静脉滴入化疗药 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 现在提倡零钢针都打留 置针 且必须当天打当天拔 除 因为留置针较短 仍有 可能脱出 异位而引起渗出 故最好行PICC置管 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处理 立即停止输液 先回抽 5 10ml血后推地塞米松5mg 并立 即拔针 同时报告医生和护士长 靠针眼上方 冰敷 用利多卡因 地塞米松 生理盐水局部封闭 再 外用京万红软膏一日涂5 6次 如 有红肿则可与硫酸镁交替进行 直 到红肿消退 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胃肠道反应 常见的 有恶心 呕吐 腹泻 便 秘和粘膜炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 护士巡视病人时应注意观 察 每天测T P R时一定 要问大便次数 目前对恶心 呕吐的预防和治疗也有很大 进展 取得了较好的疗效 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 其中 以HT3受体拮抗 剂恩丹西酮即欧贝 托烷 司琼疗效最好 呕吐控制 率可达80 加用地塞米 松可提高疗效 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 甲氧氯普胺 胃复胺 加地塞米松联合应用也可 收到较好的止吐效果 血 性腹泻时应报告医生停止 化疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 粘膜炎主要表现为口腔 炎 舌炎 食管炎及胃肠 道溃疡 引起进食疼痛 护士应做好病人的饮食指 导 加强病人口腔护理 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 骨髓抑制 是化疗最 常见的重要限制性毒副 反应 其程度出现及持 续时间及骨髓功能恢复 的时间均有不同 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial MTX Ara C 亚硝 脲类 卡铂 塞替哌 氮芥烷化剂 蒽环类抗 癌抗生素 如阿霉素 等骨髓抑制较重 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial VCR 平阳霉 素 门冬酰胺酶 顺 铂等骨髓抑制较轻 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial CTX 蒽环类 MTX Ara C长春碱类及顺铂骨髓抑 制出现快 恢复也快 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 白细胞下降最低值 一般出现在用药后一 至二周左右 约2 3 周就恢复 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 而有些药如亚硝脲类 等白细胞下降最低值出 现晚约 3 8周 恢复 也较慢 要1 2个月 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 如WBC 3 5 109 L BPC38 立 即做血培养及药敏并酌情 给予瑞白或赛格力深白治 疗 另外还可进层流病房 进行全环境保护 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肝脏毒性 表现肝细胞功能障碍 一 过性血清谷丙转氨酶升高 谷 草转氨酶升高 易引起肝损害 的药物 如大剂量MTX 左旋 门冬酰胺酶 Ara C VP16等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 全面了解患者肝病史 对肝功能状况全面评估 正 确选择药物及剂量 用护肝 药如康艾 还原型谷胱甘肽 等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 心脏毒性 引起心脏毒性的抗癌药 主要是蒽环类的抗癌药 如阿 霉素 柔红霉素 表阿霉素 大剂量也可有心脏损害 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 表 现 近期主要是窦性心动过 速 心律紊乱 停药或对症 处理后常是可逆性的 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 迟发性的心脏毒性可表现 为充血性心衰 心肌细胞肿胀 变性 心肌纤维溶解断裂 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 老年人 儿童有纵隔 心 脏 左侧乳腺放疗史及心脏 病史 均是高危因素 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 化疗前全面评估患者的心 脏功能状况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 心电监测以早期发现心肌损害 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 如发生心律紊乱 心 动过速等予抗心律紊乱药 对症治疗 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肺毒性 表现为生热 咳嗽 吸吸 困难 肺弥漫性浸润应用皮质 激素治疗有效 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 肾及膀胱毒性 表现 血清肌酐轻度增 高 蛋白尿 镜下血尿 严 重可出现尿少 无尿 急性 肾衰 尿毒症 甚至致命 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 常见可引起肾及膀胱 毒性的药物有DDP MTX CTX IFO等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 治疗前全面评估患者的肾功 能状况 对肾功能不全者禁用 有肾毒性的药物 老年患者及 有肾病史者慎用 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 大剂量水化 嘱患者化疗期间 每天喝水2000 2500ml 减化尿 液 如用IFO及大剂量CTX则还要 给予泌尿道保护剂 美司钠 以 减低膀胱毒性 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 神经毒性 常见于长春花植物碱类 顺铂等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 表 现 早期腱反射减低 消失 肢端 麻木 疼痛 肌无力 肌萎缩 自 主神经病变可产生便秘 尿潴留 体位性低血压 颅神经损害可致复 视 顺铂可致听力下降 耳鸣等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 用药时密切观察毒性反应 及时调整剂量 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 一旦出现毒性反应 应及 时停药 防止更为严重的反应 发生 及时停药后神经毒性常 常是可逆的 经数天至数月可 能恢复 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 鞘内注射时避免药物浓度过高 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 皮肤毒性 主要表现为脱发 皮肤色素沉着 角化过度及皮疹 处理 作好宣教 脱发时可戴 假发 化疗停止后头发可再生 化 疗病人应避免日晒 皮肤角化及色 素沉着停药后多可恢复 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 药物过敏反应 如左旋门冬酰胺酶 紫杉 醇 博莱霉素等 病人可出现 胸闷 气憋 呼吸困难 皮疹 血管水肿青紫 低血压休克 抢救不及时可致死 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 处 理 应上述可能药可能发生严 重速发过敏反应的抗癌药 应密切观察 特别是在用药2 小时内应密切观察患者的血 压 脉膊 呼吸等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 左旋门冬酰胺酶应 做皮试 且它和紫杉醇 用药前要常规应用地塞 米松及抗组织胺类药物 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 谢 谢 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial
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