Kelly Hanna, Harvey Donald, Moll Stephan
Department of Medicine, Division of Hematology-Oncology, School of Medicine, The University of North Carolina, Chapel Hill, North Carolina 27599, USA.
Obstet Gynecol. 2006 Feb;107(2 Pt 2):439-41. doi: 10.1097/01.AOG.0000172374.72125.3e.
Medical therapy with methotrexate is a standard practice for the commonly encountered problem of ectopic pregnancy. Methotrexate is excreted predominantly by the kidney and should be used with extreme caution in renal insufficiency. All physicians who administer methotrexate must understand its mechanism of action, distribution, and elimination to minimize potential risks to the patient.
A young, dialysis-dependent woman received a standard dose of methotrexate for an ectopic pregnancy. Prolonged methotrexate exposure resulted. The consequences-pancytopenia, desquamation, acute respiratory distress syndrome, and profound bowel ischemia-ultimately led to her death.
Methotrexate, even at extremely low doses, can be fatal in patients with renal insufficiency. Alternative means of therapy should be sought for women with ectopic pregnancy and renal failure.
对于异位妊娠这一常见问题，使用甲氨蝶呤进行药物治疗是一种标准做法。甲氨蝶呤主要通过肾脏排泄，在肾功能不全的情况下应极其谨慎地使用。所有使用甲氨蝶呤的医生必须了解其作用机制、分布和消除情况，以将对患者的潜在风险降至最低。
一名依赖透析的年轻女性因异位妊娠接受了标准剂量的甲氨蝶呤治疗。结果导致甲氨蝶呤暴露时间延长。其后果——全血细胞减少、脱皮、急性呼吸窘迫综合征和严重的肠道缺血——最终导致了她的死亡。
甲氨蝶呤即使剂量极低，对肾功能不全的患者也可能是致命的。对于患有异位妊娠和肾衰竭的女性，应寻求其他治疗方法。
