论坛 › 新疆 › 肺癌脑膜转移后最关心的21个问题，肿瘤专家是这般回答的丨答疑回顾

6257rv7 发表于 2024-6-23 18:04:02

肺癌脑膜转移后最关心的21个问题，肿瘤专家是这般回答的丨答疑回顾

<img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">点击下方关注，抗癌知识不<span style="color: black;">错失</span>~</strong></p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">答疑<span style="color: black;">大夫</span>：邹子骅<span style="color: black;">大夫</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">整理者：阿狸、三伏里的猴子、大海、柚子、桃园渔歌</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">审核：邹子骅<span style="color: black;">大夫</span>、鹰版</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">编者按：<span style="color: black;">因为</span>群内答疑时病友<span style="color: black;">供给</span>的资料不是很全面，所描述的与<span style="color: black;">实质</span>病情很可能有差异，<span style="color: black;">因此</span>群内答疑的<span style="color: black;">大夫</span>只是<span style="color: black;">按照</span>现有<span style="color: black;">把握</span>的资料和经验提出的一个治疗<span style="color: black;">意见</span>，并不是医嘱，<span style="color: black;">最后</span>治疗仍需以主治医师来确定。</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">答疑回顾</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">点击收听</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">专家介绍</strong></p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅&nbsp;</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">副<span style="color: black;">专家</span>医师</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">福建省肿瘤医院</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胸部肿瘤内科</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">副<span style="color: black;">专家</span>医师</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">本科：山东大学医学院</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">硕士、博士：中国医学科学院肿瘤医院</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">师从肺癌专家李峻岭教授</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在BMC Medicine、Translational Lung Cancer Research、Thoracic cancer以<span style="color: black;">第1</span>作者发表上SCI论文4篇</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">WCLC、ELCC国际会议壁报7项</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题一</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男61岁，2023年9月确诊：四期肺腺癌，EGFR19。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">治疗经过：</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一线靶向药，下周计划做脑部射波刀。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">咨询邹<span style="color: black;">大夫</span>：</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脑转移<span style="color: black;">病人</span><span style="color: black;">是不是</span>有<span style="color: black;">期盼</span>依靠靶向药消除脑部病灶？靶向药耐药后该<span style="color: black;">怎样</span>进行<span style="color: black;">掌控</span>？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">初治一线的EGFR经典突变的<span style="color: black;">病人</span>，接受靶向治疗的效果非常好，尤其一线<span style="color: black;">运用</span>三代靶向药颅内疗效是非常好的。<span style="color: black;">日前</span>现有的<span style="color: black;">科研</span>提示，脑转移的颅内病灶比较少的，<span style="color: black;">运用</span>靶向药<span style="color: black;">同期</span>联合立体定向放疗<span style="color: black;">（伽马刀或射波刀等）</span>，脑转移<span style="color: black;">掌控</span><span style="color: black;">状况</span>会进一步<span style="color: black;">加强</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">后续<span style="color: black;"><strong style="color: blue;">靶向药耐药<span style="color: black;">重点</span>是看<span style="color: black;">那些</span><span style="color: black;">地区</span><span style="color: black;">发展</span></strong></span>，<span style="color: black;">倘若</span>是全面<span style="color: black;">发展</span>，<span style="color: black;">意见</span>再穿刺活检<span style="color: black;">知道</span>耐药机制，<span style="color: black;">按照</span>耐药<span style="color: black;">原由</span>更换系统治疗<span style="color: black;">方法</span>。<span style="color: black;">倘若</span>只是局部的寡<span style="color: black;">发展</span>，<span style="color: black;">意见</span>局部处理，在原靶向药的<span style="color: black;">基本</span>上<span style="color: black;">协同</span>局部治疗，<span style="color: black;">例如</span>局部放疗<span style="color: black;">或</span>消融等的局部治疗。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题二</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女56岁，2022年10月确诊：4b肺癌脑膜转移，骨转移，EGFR21，TP53。&nbsp;</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2022年10月确诊肺癌脑膜转移，骨转移；因颅压过高，做了分流手术；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2022年11月全脑全脊髓放疗36Gy/18f，<span style="color: black;">出现</span>四级骨髓<span style="color: black;">控制</span>；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2022年11月<span style="color: black;">起始</span>双倍奥希替尼，后因骨髓<span style="color: black;">控制</span>严重降为1.5倍。每周2-3次升白针，血小板<span style="color: black;">长时间</span>维持在30-50，白细胞<span style="color: black;">小于</span>2；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023年9月，从奥希替尼更换为1.5倍伏美替尼<span style="color: black;">迄今</span>，<span style="color: black;">再也不</span>做升白和血小板处理。<span style="color: black;">近期</span>一次血常规血小板89，白细胞2.6。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从今年6月<span style="color: black;">起始</span>，<span style="color: black;">连续</span><span style="color: black;">显现</span>膝盖、大腿、 屁股位置<span style="color: black;">病痛</span><span style="color: black;">状况</span>，只能<span style="color: black;">经过</span>按摩和走动来缓解。前期认为是打多了升白针<span style="color: black;">导致</span>的<span style="color: black;">病痛</span>，<span style="color: black;">然则</span>从9月起<span style="color: black;">再也不</span>打升白针，依旧有<span style="color: black;">显现</span>剧烈<span style="color: black;">病痛</span>症状。请问这可能是什么<span style="color: black;">原由</span><span style="color: black;">引起</span>的？<span style="color: black;">咱们</span><span style="color: black;">必须</span><span style="color: black;">弥补</span><span style="color: black;">那些</span><span style="color: black;">检测</span>？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.&nbsp;<span style="color: black;">意见</span>做骨扫描看有<span style="color: black;">无</span>骨转移病灶的加重或<span style="color: black;">增加</span>；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.&nbsp;<strong style="color: blue;"><span style="color: black;">大概率可能是脊髓放疗后的适应症</span></strong>，<span style="color: black;">此刻</span>的血小板和白细胞水平是非常典型的脊髓放疗后<span style="color: black;">关联</span>不良反应的<span style="color: black;">表现</span>，<span style="color: black;">因此</span>更倾向于<span style="color: black;">日前</span><span style="color: black;">病痛</span>是脊髓放疗后的<span style="color: black;">副作用</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题三</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女48岁，2023年8月确诊：四期肺腺癌，ALK突变。&nbsp; &nbsp; &nbsp;</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023.8.16<span style="color: black;">起始</span><span style="color: black;">吃下</span>盐酸阿来替尼，快满两个月了。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">怎样</span>尽快<span style="color: black;">发掘</span>脑膜转移，脑膜转移有什么症状？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">ALK是非常有名的钻石突变，&nbsp;ALK<span style="color: black;">病人</span>接受靶向药治疗的效果非常好。<span style="color: black;">按照</span><span style="color: black;">科研</span>，阿来替尼一线治疗在中国人群里面疗效非常好，尤其有非常好的中枢神经系统<span style="color: black;">守护</span><span style="color: black;">功效</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">脑膜转移</span></strong>在驱动基因阳性<span style="color: black;">尤其</span>是EGFR和ALK<span style="color: black;">病人</span>身上，<strong style="color: blue;"><span style="color: black;"><span style="color: black;">出现</span>率大概是10%~15%</span></strong>，可能<span style="color: black;">仅有</span>一部分<span style="color: black;">病人</span>才会<span style="color: black;">出现</span>脑膜转移，所以<span style="color: black;">日前</span>不要对脑膜转移有<span style="color: black;">太多</span>担心。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">脑膜转移典型的症状</span></strong>，<span style="color: black;">便是</span>表现为<span style="color: black;">头昏</span>、头痛、恶心和呕吐，<span style="color: black;">同期</span>伴有神经系统受损的表现，<span style="color: black;">例如</span>听力下降、视物模糊、面瘫、咀嚼<span style="color: black;">没</span>力、肢体<span style="color: black;">没</span>力等。<span style="color: black;">倘若</span>后续<span style="color: black;">显现</span>了这些症状，要完善<span style="color: black;">关联</span><span style="color: black;">检测</span>，<span style="color: black;">例如</span>头颅核磁，初筛有<span style="color: black;">无</span>中枢神经系统转移，<span style="color: black;">包含</span>脑实质转移和脑膜转移。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题四</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女33岁，2022年1月确诊：肺癌晚期+多发脑转移，EGFR19+TP53。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">阿美替尼+2次贝伐+1次甲氨蝶呤鞘注，<span style="color: black;">此刻</span><span style="color: black;">始终</span>有头疼<span style="color: black;">头昏</span>的症状，心烦，<span style="color: black;">夜晚</span><span style="color: black;">睡觉</span>质量<span style="color: black;">亦</span><span style="color: black;">欠好</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">始终</span><span style="color: black;">吃下</span>阿美替尼，<span style="color: black;">此刻</span>能否换奥希替尼？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脑膜转移是确诊肺癌就存在还是阿美替尼治疗之后<span style="color: black;">显现</span>的脑膜转移？甲氨蝶呤鞘注是什么时候？是阿美替尼刚<span style="color: black;">起始</span>吃的时候还是在阿美替尼治疗后<span style="color: black;">显现</span>脑膜转移之后，才进行的甲氨蝶呤鞘注？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">由于</span><strong style="color: blue;"><span style="color: black;">有<span style="color: black;">显著</span>的<span style="color: black;">头昏</span>头疼症状，<span style="color: black;">首要</span>要先复查<span style="color: black;">知道</span><span style="color: black;">疾患</span><span style="color: black;">状况</span>，</span></strong>看脑核磁有<span style="color: black;">无</span>提示脑实质转移或脑膜转移加重<span style="color: black;">状况</span>。<span style="color: black;">倘若</span>脑膜转移加重，<span style="color: black;">能够</span>做腰穿跟之前的脑脊液对比，脑脊液的肿瘤标志物有<span style="color: black;">无</span><span style="color: black;">上升</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">评定</span>脑膜转移稳定，不建议从阿美替尼换到奥希替尼，基于<span style="color: black;">日前</span>现有数据，奥希替尼、阿美替尼、伏美替尼的中枢神经系统活性都差不多。<strong style="color: blue;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">评定</span>脑膜和脑实质都<span style="color: black;">发展</span>，<span style="color: black;">意见</span>再做脑脊液基因检测，<span style="color: black;">瞧瞧</span>耐药机制并针对结果<span style="color: black;">调节</span>后续治疗<span style="color: black;">方法</span>。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题五</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女65岁，2020年12月确诊中晚期肺腺癌，EGFR 21外显子p.L858R错义突变、MET扩增。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2020.12月肺部手术，淋巴结转移，术后阿美替尼。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2022年8月<span style="color: black;">起始</span>下肢栓塞、肺栓塞、脑梗、脑<span style="color: black;">流血</span>，12月确定有脑转移、甲状腺转移、淋巴结转移。基因检测MET扩增， 1月 心脏骤停住ICU半个月，出来后<span style="color: black;">吃下</span>阿美替尼2颗/天+赛沃替尼2颗/天，近期复查<span style="color: black;">发掘</span>脑部有新增病灶，且<span style="color: black;">可疑</span>脑膜转移，改<span style="color: black;">吃下</span>阿美替尼2颗/天+赛沃替尼3颗/天。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>体感除了脖子有点硬，眼睛视野<span style="color: black;">缺失</span>，<span style="color: black;">没</span>其他不适。问了俩放疗科<span style="color: black;">专家</span>，一个<span style="color: black;">意见</span>立刻进行全脑放疗，一个<span style="color: black;">意见</span>再观察<span style="color: black;">瞧瞧</span>。在<span style="color: black;">可疑</span>脑膜转移的<span style="color: black;">状况</span>下，除了做腰穿确诊以外，还<span style="color: black;">必须</span>做什么<span style="color: black;">检测</span>？<span style="color: black;">倘若</span>确诊脑膜转移，那全脑放疗<span style="color: black;">是不是</span>有必要？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">必须</span>做鉴别诊断，<span style="color: black;">知道</span>脖子硬和视野<span style="color: black;">缺失</span>是脑梗脑<span style="color: black;">流血</span><span style="color: black;">副作用</span>还是脑转移之后新<span style="color: black;">显现</span>的。</span></strong><span style="color: black;">倘若</span>是脑血管病<span style="color: black;">副作用</span>，<span style="color: black;">能够</span>推迟全脑放疗，<span style="color: black;">倘若</span><span style="color: black;">知道</span>是脑转移<span style="color: black;">关联</span>症状，并且是在阿美替尼和赛沃替尼治疗<span style="color: black;">时期</span><span style="color: black;">显现</span>并<span style="color: black;">逐步</span>加重，<span style="color: black;">能够</span>脑部放疗介入。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">可疑</span>脑膜转移<span style="color: black;">经过</span>腰穿获取脑脊液</span></strong>，找到肿瘤细胞，是最直接诊断的办法，<span style="color: black;">意见</span>进一步做脑脊液的基因检测，看能<span style="color: black;">不可</span><span style="color: black;">发掘</span>耐药靶点。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">确诊脑膜转移全脑放疗</span></strong><span style="color: black;">是不是</span>必要得<strong style="color: blue;"><span style="color: black;">分<span style="color: black;">状况</span></span></strong>，<span style="color: black;">倘若</span>有<span style="color: black;">尤其</span><span style="color: black;">显著</span>的脑实质病灶<span style="color: black;">增加</span>，<span style="color: black;">没</span>论有<span style="color: black;">无</span>脑膜转移，全脑放疗有必要的，它<span style="color: black;">能够</span>进一步<span style="color: black;">掌控</span>颅内实质病灶。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>吃阿美替尼和赛沃替尼<span style="color: black;">时期</span>，<span style="color: black;">评定</span>脑实质比较稳定，腰穿有脑膜转移，全脑放疗不必要。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题六</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男52岁，2023年1月确诊：肺腺癌晚期<span style="color: black;">（脑部+脑膜转移）</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脑部放疗，化疗，鞘注。靶向莫博赛替尼<span style="color: black;">一月</span>，之后<span style="color: black;">日前</span>伏美替尼，肺部<span style="color: black;">日前</span>稳定，脑部还会偶尔<span style="color: black;">头昏</span>胀。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">已然</span>鞘注脑侧室打药7次<span style="color: black;">上下</span>。<span style="color: black;">为何</span>还会偶尔<span style="color: black;">头昏</span>，<span style="color: black;">不可</span>运动时间过长，<span style="color: black;">否则</span>就会<span style="color: black;">头昏</span>，是不是颅压过高？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>是基因突变EGFR20<span style="color: black;">插进</span>吗？<span style="color: black;">倘若</span>是EGFR20<span style="color: black;">插进</span>，现在伏美替尼的剂量是多少？基于<span style="color: black;">日前</span>信息不认为这个症状是颅压过高<span style="color: black;">导致</span>的，<span style="color: black;">非常多</span>脑膜转移<span style="color: black;">没</span>论靶向治疗还是鞘内治疗之后，症状可能不会完全消失，只会缓解。<strong style="color: blue;"><span style="color: black;">脑膜转移的疗效<span style="color: black;">评定</span>要<span style="color: black;">同期</span>结合症状、影像学、脑脊液<span style="color: black;">关联</span><span style="color: black;">检测</span><span style="color: black;">评定</span>，</span></strong><span style="color: black;">倘若</span>这几项<span style="color: black;">检测</span><span style="color: black;">评定</span>都有好转，那脑膜转移治疗<span style="color: black;">便是</span>有效的。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题七</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女65岁，2022年12月确诊：肺腺癌四期，脑脊液检测L858R，PTEN。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2022.12月确诊肺腺癌脑膜转移。<span style="color: black;">吃下</span>双倍奥希替尼四个月后<span style="color: black;">逐步</span>又<span style="color: black;">起始</span>头疼<span style="color: black;">头昏</span>，2023.6月换成3759+贝伐，<span style="color: black;">一月</span>后又有头疼<span style="color: black;">头昏</span>的症状。2023.9.14 和18日分别鞘内注射培美各20mg，<span style="color: black;">无</span>好转反而头疼<span style="color: black;">头昏</span>更严重。<span style="color: black;">全部</span><span style="color: black;">时期</span>肺部肿瘤<span style="color: black;">始终</span><span style="color: black;">逐步</span>缩小。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">请问这种<span style="color: black;">状况</span>下，<span style="color: black;">是不是</span>还有必要继续鞘注培美？<span style="color: black;">或</span><span style="color: black;">思虑</span>鞘注其他<span style="color: black;">药品</span>？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span><span style="color: black;">此刻</span>还在用3759呢还是换回了双倍奥希替尼？<span style="color: black;">针对</span>奥希替尼治疗后<span style="color: black;">显现</span>中枢神经系统病灶<span style="color: black;">发展</span>的，不<span style="color: black;">举荐</span>再换成3759。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">后续<strong style="color: blue;"><span style="color: black;"><span style="color: black;">意见</span>做个脑脊液的基因检测，看能<span style="color: black;">不可</span>找到耐药机制</span></strong>。培美曲塞再鞘内注射两次<span style="color: black;">而后</span>评估，<span style="color: black;">倘若</span>还<span style="color: black;">无</span>效果，换鞘内注射<span style="color: black;">药品</span><span style="color: black;">例如</span>依托泊苷等。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题八</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男55岁，2022年8月确诊：肺腺癌4期，EGFR、 L858R、PI3K、MET扩增。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脑膜转移经5次鞘注后<span style="color: black;">（腰椎置管腹腔）</span>脑脊液CEA由526降至115.体感<span style="color: black;">无</span><span style="color: black;">显著</span>好转，<span style="color: black;">显现</span>侧漏<span style="color: black;">引起</span>肺炎克雷伯感染，经美罗培南抗感染2个月未<span style="color: black;">掌控</span>感染，拔除置管后<span style="color: black;">第1</span>次细菌培养阴性，<span style="color: black;">时期</span><span style="color: black;">吃下</span>阿美替尼3片<span style="color: black;">每日</span>。<span style="color: black;">日前</span>脑脊液肿瘤标志物降至36，但卧床，精神状态较前虽好转但仍较淡漠，说胡话，头颅CT未见<span style="color: black;">显著</span>脑积水。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">奥希替尼至23年6月后加倍，7月培美加卡铂化疗后尝试伏美替尼及克唑替尼，<span style="color: black;">日前</span>三倍阿美替尼。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.如颅内压继续<span style="color: black;">升高</span>，脑室腹腔分流<span style="color: black;">是不是</span>容易腹腔种植？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.<span style="color: black;">始终</span><span style="color: black;">吃下</span>阿美替尼，脑脊液肿瘤标志物<span style="color: black;">已然</span><span style="color: black;">显著</span>下降，<span style="color: black;">是不是</span>还<span style="color: black;">必须</span>腰穿鞘注？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.<span style="color: black;">是不是</span><span style="color: black;">必须</span>治疗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4.病人近期<span style="color: black;">显现</span>嗜睡、<span style="color: black;">认识</span>不清楚的<span style="color: black;">状况</span>，还有什么<span style="color: black;">办法</span>吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">脑室腹腔分流会有腹腔种植<span style="color: black;">危害</span>，颅内压越高种植<span style="color: black;">危害</span>的概率越高。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">从症状上看，<span style="color: black;">倘若</span><span style="color: black;">病人</span>体感<span style="color: black;">无</span>太大好转，<span style="color: black;">必须</span>进行鉴别诊断，排除有<span style="color: black;">无</span>颅内感染的可能，送检做病原学的NGS，<span style="color: black;">倘若</span>病原学NGS是阴性，那体感差是和脑膜转移<span style="color: black;">相关</span>的，<span style="color: black;">能够</span>再重新培美曲塞鞘注，鞘注化疗联合靶向治疗看会不会改善体感，<span style="color: black;">同期</span>完善脑脊液的基因检测找一下耐药机制。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>脑脊液病原学NGS是阳性，<span style="color: black;">意见</span>先做抗感染治疗，有可能抗感染治疗之后体感就会有好转。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题九</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男52岁，2020年10月确诊：肺腺癌VIB，EGFR19。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2010-10至2023-3靶向药 （凯美纳+安罗替尼）；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023．3<span style="color: black;">发掘</span>左手麻左腿麻经核磁<span style="color: black;">加强</span><span style="color: black;">检测</span>多发脑转部分脑膜转，埋囊鞘注全脑放疗10次<span style="color: black;">同期</span>换阿美替尼<span style="color: black;">一月</span><span style="color: black;">没</span>效；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023．6换奥希替尼2倍+化疗<span style="color: black;">迄今</span>体感较好未做<span style="color: black;">检测</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.脑膜转标准<span style="color: black;">方法</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.<span style="color: black;">必须</span><span style="color: black;">那些</span>辅助？如营养神经</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>脑膜转移<span style="color: black;">无</span><span style="color: black;">知道</span>的标准治疗<span style="color: black;">方法</span>，<span style="color: black;">针对</span>有驱动基因突变的<span style="color: black;">病人</span>，尤其EGFR、ALK，是有高中枢神经系统活性靶向<span style="color: black;">药品</span>存在的，三代EGFR-TKI、二代和三代ALK-TKI都有非常好的颅内疗效，优先<span style="color: black;">运用</span>这些<span style="color: black;">药品</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">鞘内化疗是治疗脑膜转移非常<span style="color: black;">要紧</span>的手段</span></strong>，<span style="color: black;">重点</span>用于联合高中枢神经系统活性靶向<span style="color: black;">药品</span>，<span style="color: black;">或</span>高中枢神经系统活性靶向<span style="color: black;">药品</span>耐药后的挽救。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女53岁，2020年9月底确诊：肺腺癌四期<span style="color: black;">（骨转移）</span>，EGFR21的&nbsp;L858R和L861Q突变。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2020.09-2022.10培美曲塞+奈达铂一次，之后用阿法替尼，<span style="color: black;">时期</span>肺部原发放疗了一次；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023.06确诊脑转和脑膜转移，<span style="color: black;">由于</span>肺部病灶太小取不到活检， 6月<span style="color: black;">起始</span>盲吃伏美替尼，10月初复查<span style="color: black;">表示</span>脑膜转移区域缩小，肺部<span style="color: black;">亦</span>有缩小， CEA和两个月前复查差不多在18<span style="color: black;">上下</span>，<span style="color: black;">然则</span>近<span style="color: black;">一月</span>听力<span style="color: black;">忽然</span>下降，影像科的<span style="color: black;">大夫</span>看了磁共振影像说是脑膜转移累及到了听神经，<span style="color: black;">同期</span>偶尔头蒙不<span style="color: black;">晓得</span>是不是伏美替尼副<span style="color: black;">功效</span>，<span style="color: black;">大夫</span>给了<span style="color: black;">方法</span>让先停靶向药并<span style="color: black;">起始</span>化疗几次，<span style="color: black;">这般</span>可行吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1：<span style="color: black;">大夫</span>说暂停靶向药<span style="color: black;">起始</span>化疗，化疗对头部和脑膜转移有效吗？<span style="color: black;">能够</span>暂停靶向药只用化疗吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2: <span style="color: black;">为何</span>脑膜转移区域缩小了反而会听力下降？吃伏美替尼之前是<span style="color: black;">无</span>听力下降的</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">不<span style="color: black;">意见</span>停用靶向药，<span style="color: black;">倘若</span>颅外病灶稳定，说明颅外病灶仍然对靶向药敏感。静脉化疗对脑膜转移的有效率比较低，鞘注化疗<span style="color: black;">能够</span>做。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">症状恶化的时候<span style="color: black;">必须</span>鉴别诊断</span></strong>，<span style="color: black;">倘若</span>有合并用药，<span style="color: black;">尤其</span>是耳毒性用药时，是有可能<span style="color: black;">导致</span>听力下降的，这跟脑膜转移<span style="color: black;">无</span>关系。<span style="color: black;">意见</span>再去耳鼻喉科排除非肿瘤<span style="color: black;">原因</span><span style="color: black;">引起</span>的听力下降，<span style="color: black;">倘若</span>排查过合并用药和耳鼻喉科<span style="color: black;">关联</span><span style="color: black;">疾患</span>后，是存在脑膜转移症状和影像学表现不平行的可能。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十一</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女63岁，2017.7确诊肺腺癌3b， EGFR19。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2017.7 手术；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2017.8～11 &nbsp;AC化疗4次；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2017.12～2019.1.18 未治疗 ；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2019.1.19～<span style="color: black;">迄今</span>吉非替尼；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023.8 左髋臼转移可能 &nbsp;4周一次 伊班膦酸钠6mg；&nbsp; &nbsp;</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023.9 脑核磁<span style="color: black;">加强</span>左侧额叶皮层<span style="color: black;">反常</span>信号影，<span style="color: black;">CEA从2023.3月～5月～7月～9月动态<span style="color: black;">始终</span>在<span style="color: black;">上升</span>9.0～16.4～23.9～33.6。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">读片结果：左侧额叶脑沟区见线样<span style="color: black;">反常</span>信号灶，较2019年<span style="color: black;">迄今</span>历次前片大致相仿，较2018年老片为新增。<span style="color: black;">意见</span>6个月复查头MR<span style="color: black;">加强</span>对比变化。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">读片才知晓：2019年左侧脑膜就有病灶，从2019～2023年病灶<span style="color: black;">无</span>变化，能确认软脑膜转移吗？是继续吉非替尼还是换三代奥希替尼呢？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">能够</span>用影像学诊断脑膜转移，<span style="color: black;">病人</span><span style="color: black;">日前</span><span style="color: black;">不消</span>担心这个病灶，<span style="color: black;">由于</span>吉非替尼<span style="color: black;">吃下</span>时间比较久，<span style="color: black;">时期</span>病情稳定，<span style="color: black;">思虑</span>吉非替尼对<span style="color: black;">病人</span>的肿瘤非常<span style="color: black;">敏锐</span>，<span style="color: black;">同期</span>可能肿瘤侵袭性比较低，<span style="color: black;">因此</span><span style="color: black;">意见</span>不换药，继续观察一下。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十二</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男61岁，2023年3月确诊肺腺癌1b期，EGFR&nbsp;21号突变。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3月28号做左上肺叶肺癌根治手术后，做基因检测有21号突变，四月份<span style="color: black;">起始</span>吃吉非替尼。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">三个月复查一次，9.26号半年复查时，影像学说有部分软脑膜结节强化影1.5mm，<span style="color: black;">思虑</span>可能软脑膜转移，看了影像科，<span style="color: black;">大夫</span>说<span style="color: black;">思虑</span>可能是血管影。平常偶尔有点眼花<span style="color: black;">（跟看手机看多的<span style="color: black;">状况</span><span style="color: black;">同样</span>）</span>，问下<span style="color: black;">大夫</span>这是什么<span style="color: black;">状况</span>？<span style="color: black;">此刻</span>在做基因检测，这边<span style="color: black;">大夫</span><span style="color: black;">意见</span>有靶点吃第三代药。问下<span style="color: black;">大夫</span>，这个是什么<span style="color: black;">状况</span>？<span style="color: black;">倘若</span>是的话，后期该怎么办？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">术后辅助靶向治疗<span style="color: black;">意见</span><span style="color: black;">运用</span>三代靶向药</span></strong>，<span style="color: black;">由于</span>三代的EGFR-TKI辅助治疗数据遥遥领先，尤其<span style="color: black;">针对</span>预防中枢神经系统的复发转移非常有效果。即使<span style="color: black;">此刻</span><span style="color: black;">无</span><span style="color: black;">知道</span><span style="color: black;">疾患</span><span style="color: black;">发展</span>，<span style="color: black;">意见</span>换成三代药进行辅助治疗。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>影像学上看到的软脑膜结节强化影，<span style="color: black;">不可</span><span style="color: black;">知道</span>诊断，<span style="color: black;">同期</span><span style="color: black;">病人</span>症状<span style="color: black;">亦</span>不是<span style="color: black;">尤其</span>典型，<span style="color: black;">意见</span>三个月以后随诊再看，平时<span style="color: black;">重视</span>复查，<span style="color: black;">倘若</span>等待复查<span style="color: black;">时期</span><span style="color: black;">显现</span><span style="color: black;">头昏</span>头痛<span style="color: black;">状况</span><span style="color: black;">显著</span>加重，<span style="color: black;">或</span>视力<span style="color: black;">显著</span>下降，<span style="color: black;">必须</span>把复查时间提前。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十三</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女59岁，2021年确诊：3A肺腺癌，ROS1融合。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">手术后，4次化疗25次放疗。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">现吃克唑替尼，有一年时间，担心脑转移，怎么预防。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span><span style="color: black;">吃下</span>克唑替尼属于术后辅助靶向治疗，<span style="color: black;">日前</span>ROS1等术后辅助靶向治疗，还<span style="color: black;">无</span><span style="color: black;">关联</span><span style="color: black;">科研</span>结果，<span style="color: black;">日前</span>临床治疗<span style="color: black;">方法</span>参考EGFR靶点。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">克唑替尼对血脑屏障的透过率相对低<span style="color: black;">有些</span></span></strong>，<span style="color: black;">倘若</span>后面<span style="color: black;">显现</span>复发转移，<span style="color: black;">特别有</span>可能是颅内，<span style="color: black;">倘若</span>经济<span style="color: black;">前提</span><span style="color: black;">准许</span>，<span style="color: black;">能够</span>更换为恩曲替尼进行术后辅助治疗，从既往针对晚期转移性<span style="color: black;">病人</span>的<span style="color: black;">科研</span>看，恩曲替尼<span style="color: black;">针对</span>ROS1阳性非小细胞肺癌<span style="color: black;">病人</span>的中枢神经系统<span style="color: black;">守护</span><span style="color: black;">功效</span>比较好。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十四</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女61岁，确诊：肺腺癌四期脑膜脊膜转移。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">七年前肺腺癌1a术后<span style="color: black;">没</span>任何治疗，今年发现脑膜脊膜转移，<span style="color: black;">此刻</span>在吃伏美替尼双倍。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">副<span style="color: black;">功效</span>脚趾痒肿，伏美替尼双倍可否<span style="color: black;">减少</span>，双倍会不会<span style="color: black;">更易</span>耐药，<span style="color: black;">必须</span>联其他靶向药吗？会更<span style="color: black;">很难</span>耐药吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">现有<span style="color: black;">科研</span>结果看伏美替尼双倍剂量对脑膜转移效果不错，安全性还<span style="color: black;">能够</span>。<span style="color: black;">病人</span>脚趾的痒和肿，<span style="color: black;">都数</span><span style="color: black;">状况</span>下是皮肤粘膜的不良反应，<span style="color: black;">意见</span>对症处理，伏美替尼<span style="color: black;">不消</span><span style="color: black;">减少</span>。<strong style="color: blue;"><span style="color: black;">双倍剂量不会<span style="color: black;">更易</span><span style="color: black;">显现</span>耐药。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">是不是</span><span style="color: black;">必须</span>联合其他靶向<span style="color: black;">药品</span>视<span style="color: black;">状况</span>而定</span></strong>。<span style="color: black;">倘若</span>脑脊液基因检测<span style="color: black;">发掘</span>有新的基因突变，如MET等，<span style="color: black;">能够</span>联合其他靶向药。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>数据<span style="color: black;">无</span><span style="color: black;">知道</span>的结果证明EGFR-TKI尤其三代靶向药联合抗血管<span style="color: black;">药品</span>会比单三代靶向<span style="color: black;">药品</span>治疗脑膜转移的效果更好。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十五</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男38岁，确诊：ALK肺腺癌晚期，脑转、脑膜转。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2018年确诊 克唑替尼 24个月；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2020年脑转移 阿来替尼42个月；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2023年7月 脑膜转移 洛拉替尼&nbsp;2个月。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1、洛拉替尼2个月，脑膜转移症状缓解大部分，仍有<span style="color: black;">头昏</span>头胀，脖子僵直，行走不稳，耳聋等稳定不变的症状<span style="color: black;">伴同</span>，想问一下此刻鞘注能否让这些症状消失<span style="color: black;">（多大概率）</span>？<span style="color: black;">长时间</span><span style="color: black;">头昏</span>头胀会有影响吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2、一确诊就鞘注+靶向和洛拉替尼耐药后再联鞘注培美，这两种哪个<span style="color: black;">存活</span>时间长？ &nbsp;&nbsp;一<span style="color: black;">起始</span>就靶向联鞘注耐药期远远大于单药这条路么？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3、ALK二代里面的恩沙替尼、布格替尼、塞瑞替尼对脑膜转移有效没？洛拉替尼耐药后有<span style="color: black;">无</span>吃回去的先例？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4、全脑放疗 ，全身化疗对脑膜转移有效么？还有鞘注，洛拉替尼耐药后的路怎么走？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.<span style="color: black;">没</span>论是靶向治疗还是鞘内化疗，使<strong style="color: blue;"><span style="color: black;">脑膜转移<span style="color: black;">关联</span>症状完全消失是比较<span style="color: black;">少许</span>的<span style="color: black;">状况</span>，能有<span style="color: black;">显著</span>缓解就很好</span></strong>。<span style="color: black;">日前</span><span style="color: black;">状况</span><span style="color: black;">能够</span>再鞘注缓解症状，症状完全消失的机率<span style="color: black;">日前</span><span style="color: black;">无</span>数据。<span style="color: black;">头昏</span>头胀对生活质量有影响对<span style="color: black;">存活</span>不会有太<span style="color: black;">显著</span>的影响。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.<span style="color: black;">日前</span><span style="color: black;">无</span><span style="color: black;">科研</span>证明<span style="color: black;">针对</span>脑膜转移的<span style="color: black;">病人</span>，在<span style="color: black;">拥有</span>高中枢神经活性靶向<span style="color: black;">药品</span><span style="color: black;">基本</span>上<span style="color: black;">增多</span>化疗，会比单纯<span style="color: black;">运用</span>靶向<span style="color: black;">药品</span><span style="color: black;">存活</span>更好。<span style="color: black;">病人</span><span style="color: black;">此刻</span>单用洛拉替尼或联合鞘注都<span style="color: black;">能够</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3.既往有个案<span style="color: black;">报告</span>，洛拉替尼耐药后有继发耐药靶点是<span style="color: black;">能够</span>重新吃回一代靶向药的，如L1198F耐药靶点，L1198F对洛拉替尼耐药对克唑替尼<span style="color: black;">敏锐</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4.<strong style="color: blue;"><span style="color: black;">高中枢神经系统活性靶向<span style="color: black;">药品</span>有效的<span style="color: black;">状况</span>下，不<span style="color: black;">意见</span>对脑膜转移全脑放疗</span></strong>，靶向药耐药后<span style="color: black;">能够</span><span style="color: black;">运用</span>。全身化疗对脑膜转移的有效率比较低，鞘注对脑膜转移<span style="color: black;">知道</span>有效。洛拉替尼耐药后看<span style="color: black;">是不是</span>有可靶向的耐药靶点。近期<span style="color: black;">报告</span>四代ALK-TKI NVL-655初步数据不错，<span style="color: black;">能够</span>期待后续。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十六</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">男64岁确诊：四期肺癌。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2021年4月确诊肺癌脑转、骨转、双肺转等，基因检测L858R突变，一线阿法替尼9个月耐药，头部<span style="color: black;">发展</span>，接着双倍奥希替尼至2023年5月，脑膜<span style="color: black;">发展</span>，装囊鞘注，鞘注三次后，头痛缓解头部伤<span style="color: black;">口味</span>染，停止肿瘤治疗，抗感染至9月，头痛，<span style="color: black;">起始</span>腰穿鞘注三次，头痛缓解。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">鞘注<span style="color: black;">同期</span>要不要<span style="color: black;">吃下</span>靶向药？靶向药<span style="color: black;">必须</span><span style="color: black;">减少</span>吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">连续鞘注三周20mg培美后，<span style="color: black;">无</span>头痛，<span style="color: black;">是不是</span>要维持每月鞘注，还是<span style="color: black;">能够</span>拉长鞘注时间？<span style="color: black;">必须</span>加量吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">靶向<span style="color: black;">药品</span><span style="color: black;">必须</span>继续用，<span style="color: black;">日前</span>资料看颅外病灶稳定，<span style="color: black;">能够</span>判断颅外病灶对靶向药<span style="color: black;">敏锐</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">常规剂量就<span style="color: black;">能够</span>，<span style="color: black;">倘若</span>双倍奥希替尼<span style="color: black;">显现</span>脑膜转移<span style="color: black;">发展</span>，说明双倍剂量对颅内病灶耐药，<span style="color: black;">必须</span>做脑脊液基因检测找耐药机制。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">连续鞘注后头痛消失说明治疗有效，后面<span style="color: black;">能够</span><span style="color: black;">逐步</span>拉长鞘注时间</span></strong>，先以半个月为间隔期做两三次，<span style="color: black;">而后</span>再<span style="color: black;">一月</span>做一次。剂量看<span style="color: black;">病人</span>耐受性，<span style="color: black;">倘若</span>骨髓<span style="color: black;">贮存</span>功能和身体状态都<span style="color: black;">能够</span>，后续<span style="color: black;">能够</span>继续加量。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十七</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">鞘注之前<span style="color: black;">必须</span>做什么准备工作？叶酸吃多少的？&nbsp;B12怎么<span style="color: black;">运用</span>？鞘注完多久<span style="color: black;">能够</span>用停叶酸？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span><span style="color: black;">运用</span>抗叶酸<span style="color: black;">药品</span>进行鞘注，<span style="color: black;">例如</span>甲氨蝶呤、培美曲赛、依托泊苷等，<strong style="color: blue;"><span style="color: black;"><span style="color: black;">意见</span><span style="color: black;">弥补</span>维生素B12和叶酸，<span style="color: black;">能够</span>减轻不良反应</span></strong>。<strong style="color: blue;"><span style="color: black;">叶酸<span style="color: black;">每日</span>400微克，维生素B12 &nbsp;2-3个月肌注一次1毫克，培美曲赛鞘注结束后<span style="color: black;">一月</span>停用叶酸。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十八</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">脑膜转以后没鞘注，脑脊液CEA、核磁、显微镜下看肿瘤细胞都<span style="color: black;">表示</span>好转，<span style="color: black;">然则</span><span style="color: black;">病人</span>的记忆力下降走路不稳听力下降都很厉害，那是有效还是<span style="color: black;">没</span>效呢？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">评定</span>脑膜转移疗效基于三个方面，<span style="color: black;">病人</span>症状、影像学、脑脊液<span style="color: black;">关联</span><span style="color: black;">检测</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">按照</span><span style="color: black;">此刻</span>的信息，影像学和脑脊液<span style="color: black;">检测</span><span style="color: black;">评定</span>有效，<span style="color: black;">必须</span><span style="color: black;">知道</span><span style="color: black;">病人</span>症状<span style="color: black;">详细</span>细节。<span style="color: black;">倘若</span>症状跟之前比<span style="color: black;">无</span><span style="color: black;">显著</span>加重，只是稳定，那认为治疗有效。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">全脑放疗的<span style="color: black;">副作用</span>会有<span style="color: black;">显现</span>这种<span style="color: black;">状况</span>。<strong style="color: blue;"><span style="color: black;"><span style="color: black;">倘若</span>是在接受治疗过程中<span style="color: black;">显现</span><span style="color: black;">显著</span>症状加重，那<span style="color: black;">日前</span>的治疗可能有点耐药，</span></strong><span style="color: black;">能够</span><span style="color: black;">增多</span>鞘内注射化疗改善<span style="color: black;">病人</span>症状。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题十九</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">降低颅压甘露醇<span style="color: black;">详细</span>怎么<span style="color: black;">运用</span>？<span style="color: black;">每日</span>几次？每次多少ml？连续用几天？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甘露醇<span style="color: black;">一般</span>每次25克<span style="color: black;">（半瓶）</span>。频率是12小时/次或8小时/次或6小时/次。症状比较重<span style="color: black;">运用</span>频率快；症状轻<span style="color: black;">运用</span>间隔时间<span style="color: black;">能够</span>拉长，连续用10天半个月都<span style="color: black;">能够</span>。甘露醇是<span style="color: black;">经过</span>减轻脑水肿来降低颅内压的，起到临时缓解症状的<span style="color: black;">功效</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题二十</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Ommaya囊的优缺点是什么？什么<span style="color: black;">状况</span>下<span style="color: black;">举荐</span>装囊<span style="color: black;">（病情<span style="color: black;">前提</span>，<span style="color: black;">例如</span>有<span style="color: black;">无</span>脊膜转移，有<span style="color: black;">无</span>水肿，鞘注<span style="color: black;">是不是</span>有效，颅内压多少以内等）</span>？颅内压不高的话<span style="color: black;">意见</span>装囊吗？同等剂量下<span style="color: black;">经过</span>囊鞘注会比腰穿鞘注效果好吗？两种方式的给药剂量是<span style="color: black;">同样</span>的吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">Ommaya囊最大的优点<span style="color: black;">便是</span>给药方便</span></strong>，方便<span style="color: black;">病人</span><span style="color: black;">亦</span>方便<span style="color: black;">大夫</span>，腰穿之后要平躺6小时，Ommaya囊给药不<span style="color: black;">必须</span>。<span style="color: black;">无</span>特殊<span style="color: black;">状况</span>后续要鞘注给药的话，<span style="color: black;">意见</span>安装Ommaya囊。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">Ommaya囊给药效果不比腰穿鞘注差。</span></strong>这两种给药方式的用药剂量<span style="color: black;">同样</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">装Ommaya囊<span style="color: black;">病人</span><span style="color: black;">必须</span>剃头。颅内水肿、脊膜转移都不影响放Ommaya囊。颅内压不高<span style="color: black;">亦</span><span style="color: black;">能够</span>装，给药方便，颅内压非常高会影响装Ommaya囊，<span style="color: black;">意见</span>脱水把颅内压<span style="color: black;">尽可能</span>降到正常时装Ommaya囊会安全。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题二十一</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">群友提问</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">女，69岁，2013年确诊肺腺癌1期并手术，2015年复发，ALK阳性，2017年脑转，2020年底脑膜转。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">靶向药一代，二代，三代，化疗，放疗，鞘注。7月中神智不清，<span style="color: black;">不可</span>走路，8月7日培美鞘注，8月15日昏睡，泌尿感染。抗感染 后脑脊液蛋白10万，肿瘤指标下降，9月11日培美25mg鞘注，病人醒过来，但二天后<span style="color: black;">连续</span>高烧，高血压，心率高，<span style="color: black;">呼气</span>急促，癫痫，9月19日继续鞘注30mg。脑脊液生化炎症指标高达6000，肿瘤指标<span style="color: black;">亦</span>攀升，并<span style="color: black;">始终</span><span style="color: black;">晕倒</span>。现抗感染后，生命指标稳定，多天<span style="color: black;">无</span>发烧。但脑积水仍然严重，脑蛋白19万多，<span style="color: black;">始终</span><span style="color: black;">晕倒</span>。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">咨询邹<span style="color: black;">大夫</span>：</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span>应该怎么办？<span style="color: black;">能够</span>继续尝试培美鞘注或是换药鞘注吗？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">邹子骅<span style="color: black;">大夫</span>解答</strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">意见</span>送检脑脊液做培养和病原学的NGS<span style="color: black;">知道</span>有<span style="color: black;">无</span>颅内感染。<span style="color: black;">知道</span>颅内感染后给予抗感染治疗。<strong style="color: blue;"><span style="color: black;"><span style="color: black;">无</span><span style="color: black;">知道</span><span style="color: black;">是不是</span>有颅内感染之前不<span style="color: black;">意见</span>鞘注治疗。</span></strong><span style="color: black;">倘若</span>脑脊液细菌培养和病原学NGS是阴性，就<span style="color: black;">思虑</span>脑膜转移<span style="color: black;">引起</span>，<span style="color: black;">此刻</span>培美曲塞鞘注剂量相对高，<span style="color: black;">无</span><span style="color: black;">尤其</span>大的中枢神经系统症状改善的话，后续可能<span style="color: black;">无</span>太好办法。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">感谢<span style="color: black;"><strong style="color: blue;">林根教授团队</strong></span>为肺癌脑膜转移<span style="color: black;">病人</span><span style="color: black;">供给</span>专业医学支持，<span style="color: black;"><strong style="color: blue;">“因爱有福·肺癌脑膜转移<span style="color: black;">病人</span>关爱行动”</strong></span>仍在继续，<span style="color: black;">期盼</span>广大<span style="color: black;">病人</span>和家属<span style="color: black;">伴侣</span>多提需求、多说<span style="color: black;">意见</span>、多做批评，<span style="color: black;">帮忙</span><span style="color: black;">咱们</span>与医学专家团队<span style="color: black;">一起</span>将“因爱有福”项目做得更好，切实改善脑膜转移<span style="color: black;">病人</span>的<span style="color: black;">存活</span><span style="color: black;">状况</span>，推进肺癌脑膜转移的治疗进步，蹚出一条规范化治疗的可行之路。</p>
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">微X</span>添加小助理，您<span style="color: black;">能够</span><span style="color: black;">得到</span>：①免费咨询肿瘤<span style="color: black;">关联</span>问题②有奖征稿③临床<span style="color: black;">实验</span>④下载APP加入病友群。</p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">文案</span>声明：本文中所<span style="color: black;">触及</span>的信息旨在传递医药前沿信息和<span style="color: black;">科研</span><span style="color: black;">发展</span>，不<span style="color: black;">触及</span>诊疗方案<span style="color: black;">举荐</span>，临床上请遵从<span style="color: black;">大夫</span>或其他医疗卫生专业人士的意见与<span style="color: black;">指点</span>。</p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">星标关注，精彩内容不<span style="color: black;">错失</span>！</p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
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听听海 发表于 2024-9-8 04:14:17

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