Georgia Cancer Specialists, Atlanta, GA.
Emory University Hospital, Brookhaven, GA.
Semin Oncol Nurs. 2021 Apr;37(2):151136. doi: 10.1016/j.soncn.2021.151136. Epub 2021 Mar 17.
To provide an overview of tumor lysis syndrome, which is one of the metabolic oncologic emergencies.
A review and synthesis of empirical articles.
One of the metabolic oncologic emergencies identified by the Oncology Nursing Society is tumor lysis syndrome. This condition is life-threatening and is characterized by metabolic derangements that can lead to acute kidney injury and multiple organ dysfunction. Normal intracellular components (potassium, phosphorus, and nucleic acids) spill into the bloodstream when cancer cells die. If the tumor is large and highly responsive to chemotherapy, the resulting cascade of dead tumor cells may overwhelm normal homeostatic mechanisms. The cells enter the bloodstream faster than they can be cleared by the kidneys. This results in hyperkalemia and hyperphosphatemia. Nucleic acids convert to uric acid in the liver with a resultant hyperuricemia. Excess uric acid in the kidneys can lead to uric acid nephropathy and renal insufficiency. Phosphorus binds with calcium, leading to hypocalcemia from the formation of calcium phosphate precipitate or crystals. These crystals can also lead to renal insufficiency or acute kidney injury, which can lead to a metabolic acidosis and exacerbation of the hyperkalemic state. These metabolic derangements define presence of tumor lysis syndrome.
Multidisciplinary collaboration and communication is essential to identifying patients at risk prior to treatment. Meticulous nursing care in terms of prevention and treatment is critical to patient survival.
概述肿瘤溶解综合征，这是一种代谢性肿瘤急症。
对经验性文章的回顾和综合。
肿瘤溶解综合征是肿瘤护理学会确定的代谢性肿瘤急症之一。这种情况危及生命，其特征是代谢紊乱，可导致急性肾损伤和多器官功能障碍。当癌细胞死亡时，正常细胞内成分（钾、磷和核酸）会溢出到血液中。如果肿瘤较大且对化疗高度敏感，那么大量死亡的肿瘤细胞可能会使正常的体内平衡机制不堪重负。细胞进入血液的速度比肾脏清除的速度快。这会导致高钾血症和高磷血症。核酸在肝脏中转化为尿酸，导致尿酸过多引起的高尿酸血症。肾脏中的尿酸过多会导致尿酸肾病和肾功能不全。磷与钙结合，形成磷酸钙沉淀或晶体，导致低钙血症。这些晶体也可导致肾功能不全或急性肾损伤，进而导致代谢性酸中毒和高钾血症的加重。这些代谢紊乱定义了肿瘤溶解综合征的存在。
多学科协作和沟通对于在治疗前识别有风险的患者至关重要。细致的护理预防和治疗对于患者的生存至关重要。
