Careofhigh-dosemethotrexateforadultswithacutelymphoblasticleukemiaLargedosesofmethotrexate(HD-MTX),isthepreventionandtreatmentofadultacutelymphoblasticleukemia,andextramedullaryleukemiaandsystemicconsolidationandeffectivemeasurestostrengthenthetreatment.Tetrahydrofolate(CF4calciumrescue,buttheHD-MTXisametabolicanti-tumordrugtoxicity,thecourseoftreatmentisoftenaccompaniedbyvaryingdegreesoftoxicity,toensurethesuccessfulcompletionofchemotherapy,nursingisthekey.ourdepartmentfromOctober2008toDecember2010,20casesofadultacutelymphoblasticleukemiapatients,HD-MTXintensivetherapyandhaveachievedgoodresults,areasfollows:1clinicaldata1.1GeneralInformation13malesand7females,age16-48yearsold,medianagewas28yearsold,werediagnosedwithacutelymphoblasticleukemia.HadusedstandardVMLP(vincristine,MiTuoenquinone,L-asparaginaseenzymeprednisoneprogramorVDLP(vincristine,daunorubicin,L-asparaginase,1prednisoneprogram1-2courses,achievedcompleteremission.1.2treatmentandtheeffectofThiscourseoftreatmentbeforethepatientswereroutinelychecktheheart,liverfunction,bloodandnormaloralandperianalskinandmucousmembraneintegrityofMTXeachdose3-5g/m2first1/3oftotalsurprisetheamountaddedtothesaline100mlThe0.5hdropfinished,themarginbyadding1000mlsaline23.5huniformdropsfinished,theinfusionshouldbedark.Openapathtoaddalotofliquids(2000-3000ml/day)tomaintain72h,adequatehydrationandalkalization.Morewatertoensurethatthedailyurineoutputislessthan2000ml.Gargledailywithleucovorin24mgaddedtothesaline500mlconfiguredasamouthwash,gargle.theendoftheHD-MTXintravenously12hoursbegantoberescuedbyCF4,anditstotalis10-15%ofthetotalofMTX,thefirst1/2theamountofnormalsaline0.5hdropsin100mlfinished,aftereachintervalof6hforatotalofsixtimes,morethan1/2theamountofintramuscularinjectioniscompletedshallbeperformedwhenaccuratedose.2HD-MTXchemotherapy,20patientsweretreatedwiththesuccessfulcompletionofthiscourseoftreatment.Twocasesofvomiting,oralulcersin3cases,2casesofimpairedliverfunction,onecasesofnosebleeding,threecasesofbonemarrowsuppression,improvedaftertreatment.2care2.1ThepsychologicalcareHD-MTXtreatmenttodothepsychologicalcareofpatientsandtheirfamilies,toeliminatetheanxietyandfears.Informchemotherapypurposes,methodsandprecautions,andpossibleadversereactionstoobtainthesupportandcooperationofpatientsandtheirfamiliesandtosignthemedicalrecordsthecourseoftreatmentoftenpatrolthewards,tocommunicatewithitsconcernforthepatient,patientlyexplainedandinformitsdisease-relatedknowledgeandtreatment,tocitethetreatmentofcasesofgoodeffects,andconfidencetoactivelycooperatewiththetreatment.2.2basedcareTokeepwardscleanandquiet,freshairandsuitabletemperatureandhumidity,temperature322-24°C,humidity50-60%.Thewardeverydaywith1:100sodiumdichloroisocyanuratesoakedmoptowipetwice,every30minutes.Restrictionsonvisits,ifnecessary,wearamaskconditionsallowthosewhocanbeadmittedtoawardofthelaminarflow,theimplementationofprotectiveisolationduetothechemotherapydrugathighconcentrationsofvascularirritationlarge,chooseaflexiblephlebitisthickstraightbloodvesselsafterinfusionwithsalineredtube,toensurethattheintravascularstepupinspectionstoobservetheskinpuncturesiteredness,swellingpain,exudateinfusionforalongtime,andenhancepersonalhygiene,ifnecessary,tohelppatientskeepthebedunitcleanandtidy,maintaininggoodoralperianalskinclean.2.3toxicitiescare2.3.1reducethegastrointestinalreactions...