Meggs W J, Hoffman R S
New York City Poison Center, New York, USA.
J Toxicol Clin Toxicol. 1998;36(3):243-6. doi: 10.3109/15563659809028947.
Inadvertent intrathecal administration of vincristine has been reported and is uniformly fatal except in two of three cases treated with spinal fluid exchange. We report a case of inadvertent direct intraventricular vincristine administration.
A 59-year-old woman developed acute lymphocytic leukemia with meningeal involvement and was being treated with intraventricular cytarabine (beta-cytosine arabinoside, Ara-C) injected via an Ommaya reservoir, intravenous (i.v.) vincristine, prednisone, and i.v. daunorubicin. The vincristine (2 mg in 10 mL diluent) was inadvertently injected into her Ommaya reservoir. Within 10 minutes, the error was realized. Despite optimal care, nausea and vomiting developed the first night, followed sequentially by coarse tremor, disorientation, horizontal nystagmus, and stupor. Her mental status waxed and waned until day 9, at which time she became responsive only to noxious stimuli. By day 11, she was deeply comatose and on day 40 she died without regaining any neurological function.
Despite aggressive and immediate therapy, intraventricular vincristine infusion produced neurologic toxicity, with progressive loss of mental function, followed by coma and death. Systems need to be developed to prevent inadvertent central nervous system administrations.
已有报道称长春新碱意外鞘内给药，除了三例接受脑脊液置换治疗的患者中有两例存活外，其余均为致命情况。我们报告一例长春新碱意外直接脑室内给药的病例。
一名59岁女性患急性淋巴细胞白血病并伴有脑膜受累，正在接受通过奥马亚贮液器注射脑室内阿糖胞苷（β-胞嘧啶阿拉伯糖苷，Ara-C）、静脉注射长春新碱、泼尼松和静脉注射柔红霉素治疗。长春新碱（2毫克溶于10毫升稀释液中）被意外注入她的奥马亚贮液器。10分钟内发现了这一错误。尽管给予了最佳治疗，但第一晚仍出现恶心和呕吐，随后依次出现粗大震颤、定向障碍、水平眼球震颤和昏迷。她的精神状态起伏不定，直到第9天，此时她仅对有害刺激有反应。到第11天，她陷入深度昏迷，第40天死亡，未恢复任何神经功能。
尽管进行了积极及时的治疗，但脑室内注入长春新碱仍产生神经毒性，导致精神功能逐渐丧失，随后昏迷并死亡。需要建立相关系统以防止意外的中枢神经系统给药。
