奥沙利铂致外周神经毒性症状特性及变化趋势的纵向研究

目的探讨肠癌患者使用奥沙利铂期间外周神经毒性症状特性、变化趋势及非药物影响因素。方法对113例使用奥沙利铂肠癌患者,采用神经毒性患者自述问卷（PNQ）于累积剂量达200mg/m2、540mg/m2、850mg/m2时进行随访调查,评估外周神经毒性症状的严重度;Podo触觉测量笔及温度觉测量笔分别检测患者触觉及温度觉有无异常。结果首次使用奥沙利铂后88.5%患者出现肢体感觉异常,首发表现以手部麻木为主,其次为刺痛。不同累积剂量时外周神经毒性严重度比较,差异有统计学意义（均P〈0.01）;当累积剂量达200mg/m2、540mg/m2时,不同给药方式的患者外周神经毒性严重度比较,差异有统计学意义（P〈0.05,P〈0.01）。4例患者触觉减弱。结论肠癌患者使用奥沙利铂期间感觉神经损伤发生率高于运动神经损伤,且程度较重;随着剂量的累积,外周神经毒性症状越严重。健康教育时应提供针对性指导,鼓励患者使用中心静脉导管给药,可有效避免化疗前期肢体感觉异常,延缓外周神经毒性症状加重。

Longitudinal study on oxalipiatin induced peripheral neuropathy： symptom features and changing pattern

Objective To describe symptom features,changing pattern,and non-pharmacological factors of oxaliplatin induced peripheral neuropathy.Methods One hundred and thirteen colorectal cancer patients receiving oxaliplatin-based chemotherapy were investigated by using the Patient Neurotoxicity Questionnaire when the dose of oxaliplatin was accumulated to 200mg/m2,540mg/m2,and 850mg/m2.Touch and temperature sensation were tested with the Podo touch-measuring pen and the temperaturemeasuring pen.Results About 88.5%of the patients experienced meropresthesia after receiving chemotherapy for the first time.The early symptom was mainly hand numbness,followed by tingling.Significant differences were found in severity of peripheral neuropathy at different accumulated doses and in patients using different administration methods when the dose accumulated to 200mg/m2 and 540mg/m2（P〈0.05,P〈0.01）.Four patients had impaired touch sensation.Conclusion The damage of sensory nerve is more common and severe than the motor nerve in colorectal cancer patients receiving oxaliplatin-based chemotherapy,and the severity of neurotoxity is increased as the dose accumulated.We should provide targeted education and encourage patients to receive medication through central venous catheters,so as to avoid meropresthesia in early chemotherapy and delay the development of peripheral neuropathy.