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作者等报告了2例头颈部鳞癌患者顺铂化疗引起的急性溶血性尿毒综合征(HUS),出现大量溶血,严重血小板减少,透析依赖性肾衰,血浆置换两例都无效,但第2例用葡萄球菌蛋白A柱进行血浆灌注出现戏剧性的持久反应.例1患后磨牙三角区广泛性鳞癌接受两个疗程的术前化疗,方案为顺铂120mg(80mg/m~2)第1天;长春新碱2mg第1天;博来霉素22单位/天持续静点5天.第16天化验及末梢血涂片呈现溶血性尿毒综合征改变.第20天进行了血浆置换共三次,但病情无改善于第33天死亡.例2为右下颔下肿物病理为咽鳞癌复发,入院接受第2疗程化疗,方案为顺铂20mg/m~2;5FU1000mg/m~2;博来霉素20单位/天定时静点共4天.6天后患者持续不适,恍惚.据化验检查及末梢血涂片诊为治疗相关TTP或HUS.患者输新鲜冻干血浆无反应,又进行了4次血浆置换亦无效.第15天无尿,每周需透析两次,大量红
The authors reported 2 cases of acute Hemolytic Uremic Syndrome (HUS) caused by cisplatin chemotherapy in 2 patients with head and neck squamous cell carcinoma. There was no evidence of massive hemolysis, severe thrombocytopenia, dialysis-dependent renal failure, and plasma exchange in both cases. However, Two patients experienced a protracted, long-lasting plasma perfusion with the Staphylococcal Protein A column.Example 1 The extensive squamous cell carcinoma of the affected area in the molars received two courses of preoperative chemotherapy with cisplatin 120 mg (80 mg / m 2) 1 day; vincristine 2mg on day 1; bleomycin 22 units / day for 5 days on day 16. Day 16 tests and peripheral blood smears showed hemolysis uremic syndrome changes on the 20th day of total plasma exchange Three times, but the condition did not improve died on the 33rd day .Two patients with right lower lobe tumor pathology recurrence of pharyngeal squamous cell carcinoma, admitted to the second course of chemotherapy, the program cisplatin 20mg / m ~ 2; 5FU1000mg / m ~ 2 ; Bleomycin 20 units / day for a total of 4 days of fixed time .6 days after the patient continued discomfort, trance .According to laboratory tests and peripheral blood smear diagnosis for treatment-related TTP or HUS. Patients with fresh freeze-dried plasma no response, and 4 plasmapheresis was also ineffective.Animals on the 15th day, dialysis twice a week, a large number of red