化疗副作用因人而异的原因和处理方法

化疗副作用因人而异的原因和处理方法

第一节  肠癌几个化疗药的副作用及注意事项

5-fu(氟尿嘧啶)

  副作用:食欲减退、恶心、呕吐、口腔炎、腹痛、腹泻、骨髓抑制、脱发、严重者血便、肠穿孔

  注意事项:350ml-500ml/m2输注4-8小时,用药前予以甲酰四氢叶酸静滴,开始用药42分钟内滴速240ml/h.注意粘膜反应观察与处理,出现口腔炎予以口腔护理,腹泻每日5次以上或者出现血性腹泻者通知医生,必要时停药。持续静滴者,建议使用深静脉置管。

卡培他滨(希罗达)

  副作用:骨髓抑制,恶心、呕吐、腹泻、手足综合征(手掌――足底感觉迟钝或者化疗引起肢端红斑,是一种皮肤毒性)、口腔炎、疲乏、发热。

  注意事项:每日总剂量分早晚两次于饭后半小时用温水200ml吞服,使药物尽快到达肠腔,减少消化道反应。连续服用2周,休息一周为一个周期。用药后不能接触冷水,金属物品,外出时带上口罩,手套,避免冷刺激引起喉头水肿,尽量穿长衣裤,避免阳光照射,同时使用防晒用品防护。做好口腔护理,出现严重口腔炎需要调整用药剂量,出现2级腹泻(4-6次/天,或者夜间腹泻)或以上时,立即停用本药,按照常规治疗腹泻,直至停止或2级时,再重新使用本药。

伊立替康(开普拓,艾力)

  副作用:胃肠道反应:延迟性腹泻(用药24h后发生),急性胆碱能综合征:早发性腹泻及其他症状,如用药后第一个24小时内发生腹痛、结膜炎、鼻炎、低血压、血管舒张、出汗、寒战、全身不适、头晕、视力障碍、瞳孔缩小、流泪及流涎增多。白细胞、血小板减少、贫血及骨髓抑制合并感染。

  注意事项:静滴30-90分钟,本药稀释后立即使用。用药期间患者避免食用可能引起腹泻的食物及饮料,禁用增加肠蠕动的药物。使用艾力后,身边需要常备易蒙停。用药后24小时后,一旦出现稀便或者异常蠕动,必须立即开始易蒙停治疗(2小时之内),其用法为:首次口服2#,然后每隔2小时口服1#,至少12小时,一直用到腹泻停止12小时为止,但是总用药时间不超过48小时,且不用于预防用药。与亚叶酸、5-fu联合应用,应先使用本药。

奥沙利铂(乐沙定,艾恒)

  副作用:神经毒性,胃肠道反应,腹泻,血液学毒性

  注意事项:本药必须在氟尿嘧啶前给药,静脉输注2-6小时,不要与碱性药物或者溶液或者氯化物,包括任何浓度的氯化钠一起使用。与铝接触后会降解,使用奥沙利铂时候本能使用铝制容器。低温可致上呼吸道痉挛和周围神经毒性反应,注意保暖。用药结束后一周内手足不宜接触冰冷物体,包括冷水和冷空气,注意保暖,避免冷刺激而出现上呼吸道痉挛及感觉障碍

第二节  化疗期间口腔系列炎症的缓解方法和因化疗伤胃导致胃炎的处理方法

化疗期间化疗副作用引致的口腔粘膜炎及口腔炎的缓解方法   

化疗期间化疗药会破坏口腔黏膜,导致口腔发炎,牙齿发酸,牙齿松脱,口腔溃疡,患者只要每天用淡盐水漱口8-10次就能够缓解,严重的多漱口几次就行!不能够使用带有酒精的漱口水漱口,会加重口腔炎的病情!口服化疗药还会破坏患者的味蕾,导致患者口味变淡,吃饭时,要备用榨菜丝等味道比较重的咸菜,患者感觉菜太淡没有胃口时,可以吃一口咸菜。

化疗期间化疗药伤肠胃,治疗期肠胃炎的发现和护理方法

患者化疗期间因为化疗药非常伤胃,原来有老胃病的患者通常化疗几次之后都会有胃炎的情况发生,我原来就几十年的老胃病,虽然2015年得肠癌的前几年都没有胃疼的情况,但是化疗期间就老是感觉胃不舒服和反酸,直到做胃镜时发现胃炎、胃溃疡,林医生开了一个月40mg的奥美拉挫特效胃药让我吃,我自己又买了奥美拉挫自己吃一个月,几个月之后做胃镜胃炎、胃溃疡都消失了。

患者在化疗几次之后发现吃饱之后有胃胀气反胃,或者反酸,或者直接感觉胃疼,都要要求医生开20mg的奥美拉挫胃药配着吃,胃镜发现胃炎、胃溃疡的患者就要让医生开4-mg的奥美拉挫特效药吃,护理好肠胃的健康消化功能才能健全,才能够有效率的消化吸收多吃的高蛋白食物。

第三节  肿标报告里两个非特异性肿瘤标志物ca199与ca724轻微升高的启示

其实,患者做肿瘤标志物检查的时候,肿瘤标志物其中两个检查项目跟肠胃炎症有一定的关系,一个是糖类抗原ca-724, 它是非特异性肿瘤标志物;该指标升高并不代表就是患了胃癌,肠癌患者ca-724稍微升高,经验上绝大多数是患者化疗之后有了胃炎,ca724大幅超标合并癌胚抗原cea大幅超标医生会高概率怀疑是胃癌,而ca724轻微超标而癌胚抗原正常,肠癌群经验上把它作为一个胃炎指标看待,往往非常正确,通常医生或自己配20-40mg的奥美拉挫胃药吃1个月,指标就会下降到合格的范围内,患者的胃炎症状也会消失或减缓。

另一个医生做肿瘤标志物检查的肿瘤敏感指标是糖类抗原ca199。正常值<37.00u/ml,轻度升高可见于消化道炎症;明显升高可见于消化道肿瘤,有助于胰腺癌、大肠及直肠癌的诊断 ,通常肠癌患者康复复查期ca199合并癌胚抗原cea一起升高,医生会高度怀疑患者原位复发;也常见于确诊前后手术前的患者肿标报告里;治疗期和复查期ca199轻微升高往往会把患者和家属吓一大跳;但是,肠癌群经验上往往是患者吻合口炎、或者放射性直肠炎所引致;术后治疗期和康复期ca199轻微升高把它看成是肠炎指标,往往非常准确,治疗期和康复期患者ca199升高,而医生不置可否时也没有开相应治疗肠炎的药物时,患者要注意自己是否有吻合口炎或放射性直肠炎以及各类的肠炎,有的话要做好相应的护理和调理工作。

根据6年的癌群解答经验总结,此类治疗期或康复期ca199轻微上升的患者在服用几次凉血凉肠中草药木棉花水之后,和药膏或栓剂调理好吻合口炎之后,通常下次复查ca199会恢复到正常的范围内。

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