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化疗药物及其他非抗肿瘤发疱剂外渗引起的损伤

Authors
Aimee S Payne, MD, PhD
Diane MF Savarese, MD
Section Editor
Reed E Drews, MD
Deputy Editor
Michael E Ross, MD
Translators
方勇, 主任医师

引言

外渗是指药物渗漏入血管外间隙，包括从血管漏出或直接浸润[1]。尽管许多药物进入血管外组织后均具有刺激性，但发疱剂的外渗则可能引起严重和/或持续的组织损伤。虽然最广为人知的发疱剂为细胞毒化疗药物(表 1)，但数种非抗肿瘤药物也具有发疱特性(表 2)。

化疗和非抗肿瘤性发疱剂引起外渗损伤的发生率、危险因素、临床表现、预防及处理将总结在此，其中化疗药物引起的外渗损伤是重点。化疗的其他皮肤并发症以及药物(主要见于长春瑞滨和表柔比星)接触完好静脉时诱发的静脉刺激(化学性静脉炎)将在别处进行讨论。 (参见“Cutaneous side effects of conventional chemotherapy agents”)

发生率和危险因素

发生率 — 因为没有中心报告机制，所以化疗发疱剂外渗的真实发生率还不清楚。随着对药物外渗危险的认识不断加深，外渗事件的发生率似乎已有所下降。

来自MD安德森癌症中心的数据表明，在15年间，根据化疗给药次数，严重外渗损伤(根据患者被转至整形外科的转诊模式来确定)的发生率已从0.1%下降至0.01%[2]。然而，这项病例系列研究仅纳入了被转诊至整形外科的患者，而非所有外渗损伤患者，发生率的分母则为6年研究期间所有的化疗给药次数。因此，这一数据可能低估了化疗外渗损伤的真实发生率。此外，该数据可能没有反映其他临床环境中外渗损伤的实际发生率。

发疱性抗肿瘤药物的输注通常采用中心静脉通路装置(central venous access device, CVAD)完成，以尽量减小皮下外渗的可能性。虽然化疗药物通过CVAD外渗的风险较小，但并不是没有风险，外渗也可能由注射技术或装置故障引发：

                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-20.
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