【摘要】 目的 ：探讨大剂量甲氨蝶呤（MTX）治疗原发或继发性中枢神经系统淋巴瘤的疗效及不良反应的防治。方法：对20例行大剂量MTX化疗的原发或继发性中枢神经系统淋巴瘤患者进行临床观察，并对化疗引起的不良反应进行干预，确保治疗的按时进行及疗效。结果 ：一线、二线及三线化疗有效率分别为66.7%,66.7%和50.0%。20例患者72 h MTX浓度均降至安全范围。主要不良反应为白细胞和中重度血小板减少、重度血红蛋白降低、轻中度肝功能损害及中度口腔溃疡，经干预均得到缓解。结论 ：规范治疗、MTX血药浓度监测及延续性护理干预可显著降低大剂量MTX患者的不良反应，提高患者依从性，保障临床疗效。更多还原

【Abstract】 Objective: To investigate the efficacy of high-dose methotrexate(MTX) in the treatment of primary or secondary central nervous system lymphoma and the prevention and treatment of adverse reactions. Methods: Twenty cases of the patients who underwent high-dose MTX chemotherapy were clinically observed and their adverse reactions were intervened.Results: The efective rate of the first-, second-and third-line chemotherapy were 66.7%, 66.7% and 50.0%, respectively. The MTX concentrations at 72-hour were all dropped to a safe range in 20 patients. The main adverse reactions were leukopenia and moderate to severe thrombocytopenia, severe hemoglobin reduction, mild to moderate liver function damage and moderate oral ulcers and were all relieved after intervention. Conclusion: Standardized treatment, MTX blood concentration monitoring and continuous nursing intervention can significantly reduce the adverse reactions in the patients with high-dose MTX, improve patient compliance, and ensure the therapeutic efect.更多还原