1, local irritation Certain cytotoxic drugs such as anthracyclines and vincristine drugs injected, once from the blood vessels overflow to the surrounding tissues, there will be local redness, swelling and pain, and further serious skin ulcers or tissue necrosis. Drug spillage can also cause joint stiffness at the site of spillage. The degree and extent of injury is related to the concentration of the drug and the amount of drug leaked. Tissue toxicity caused by anthracyclines and mitomycin may be related to tissue damage from the superoxide radicals formed. Different drugs spillover can cause different degrees of damage, e.g., drugs that can cause severe tissue necrosis include Vincristine, anthracyclines, aminobenzacridine, actinomycin-D, and mitomycin. Drugs that can cause moderate damage are paclitaxel, mitoxantrone, fluorouracil, platinum, bleomycin, etoposide. Drugs that cause mild local irritation are methotrexate, dacarbazine, carmustine, mentholase, and tiotropium. To prevent spillage of chemotherapeutic drugs, injections should be carried out by experienced healthcare professionals to avoid drug spillage as much as possible. Once the drug overflow occurs, the injection should be stopped immediately, and appropriate treatment should be given according to different drugs. 2.Bone marrow inhibition Granulocytopenia often occurs in the course of chemotherapy, and the effects of different drugs on the bone marrow will have different reactions. When the granulocyte decrease is less than 1.5×109/L, the risk of complication infection increases, and when the granulocyte decrease is less than 0.5×109/L, the risk of complication serious infection increases. The time of granulocytopenia and recovery time caused by different chemotherapeutic drugs are different. 3.Gastrointestinal reaction Nausea, vomiting and other gastrointestinal symptoms are the most common adverse reactions during chemotherapy. According to statistics, during chemotherapy, about 70%~80% of patients have different degrees of gastrointestinal adverse reactions, which is one of the most unbearable pains for patients. Vomiting can be categorized as acute vomiting, delayed vomiting and anticipatory vomiting. Vomiting occurs after 30 minutes to 24 hours of chemotherapy as acute vomiting, such as nitrogen mustard, streptomycin, actinomycin-D, etc. Acute vomiting often occurs. Vomiting that occurs after 24 hours of chemotherapy and up to day 5-7 is delayed vomiting, such as cisplatin and other cytotoxic drugs. Vomiting that occurs before the next cycle of chemotherapy is anticipatory vomiting. It occurs mostly as a result of conditioning. The degree of nausea and vomiting is categorized into four grades, grade 0: asymptomatic, grade 1: mild vomiting (1-2 episodes), grade 2: moderate vomiting (3-5 episodes), and grade 3: severe vomiting (>5 episodes). If you vomit several times within 1 minute, count it as 1 episode, and if you vomit 1-5 times within 5 minutes, count it as 1 episode of vomiting.WHO classification, grade 0: asymptomatic, grade 1: nausea, grade 2: transient vomiting, grade 3: vomiting that requires treatment, grade 4: persistent vomiting that is difficult to control. Nausea and vomiting affect the quality of life and the smooth progress of chemotherapy. Severe vomiting can lead to dehydration, electrolyte disorders, and even make patients refuse chemotherapy. In addition to chemotherapeutic drugs directly stimulate the gastrointestinal tract to cause vomiting, chemotherapeutic drugs in the blood can cause the release of 5-hydroxytryptamine (5-HT) from chromaffin cells in the intestinal wall, which acts on the 5-HT3 receptor in the small intestine, and then is activated and transmitted through the vagus nerve to the chemosensory evoked zone located in the last zone of the fourth ventricle, and at the same time, 5-HT can directly activate the 5-HT3 receptor of the CTZ, which can directly activate the vomit located in the medullary center in the medulla oblongata to trigger acute or delayed vomiting. According to the different factors that cause nausea and vomiting, it is extremely important to treat the symptoms in time to reduce the adverse effects. After chemotherapeutic drugs enter the body, most of them are activated and metabolized by the liver and excreted by the kidney. In this process, the burden to the liver and kidney is incalculable. Therefore, it is recommended to check the liver and kidney function before each cycle of chemotherapy, and adjust the drug dose or change the drug in time if dysfunction is found. The following drugs have certain damage to liver function and need to be carefully selected: methotrexate, cytarabine, mercaptopurine, leucovorin, cyclophosphamide, dacarbazine, carmustine, lomustine, mitomycin, actinomycin-D, bleomycin, streptomycin, phosgene, carboplatin, and menthyl amidase. When the above drugs have obvious damage to the liver, they can be carried out simultaneously with hepatoprotective therapy. In case of serious liver damage, stop chemotherapy in time, actively carry out liver-protecting treatment, and evaluate the reserve function of the liver, and formulate the treatment plan according to the test results of serum bile acid, bilirubin, prothrombin time, serum albumin, serum indocyanine green clearance test, and so on. 5, nephrotoxicity Especially cisplatin, methotrexate and other drugs have serious damage to the kidneys, the use of cisplatin should be routinely hydrated, high-dose methotrexate chemotherapy needs to be hydrated, alkalized, diuretic, and relief therapy. Glomerular filtration rate (GFR) calculation of drugs for renal insufficiency Assessment criteria for degree of renal impairment Normal value GFR >100ml/min Mild impairment GFR 40~60ml/min Moderate impairment GFR 10~40ml/min Severe impairment GFR <10ml/min Calculation method of glomerular filtration rate: I. Ccockcroft--Cault Calculation Method Male glomerular filtration rate (GFR) = (140 age) x body weight (kg) 72 x blood creatinine (umol/L) Female glomerular filtration rate (GFR) = GFR (male) x 0.85 ii. Jelliffe's Calculation Method Male glomerular filtration rate (GFR) = [980.8 x (age 20)] x body surface area 1, 73 x blood creatinine (umol/L) Female glomerular filtration rate (GFR) = [980.8 x (age 20)] x body surface area 1, 73 x blood creatinine (umol) /L) Female glomerular filtration rate (GFR) = GFR (male) × 0.9 6. Cardiotoxicity Among the antineoplastic drugs, some of them produce cardiotoxicity, and arrhythmia, pericarditis, myocardial ischemia and cardiomyopathy are common in clinical practice. Especially anthracycline cardiotoxicity is more common, acute cardiotoxicity can appear a few days after the use of drugs, mostly manifested as transient supraventricular arrhythmia, can disappear after stopping the drug. Chronic cardiotoxicity can occur months or years or more than ten years after use of the drug, with congestive cardiomyopathy as the main manifestation, most often manifested as arrhythmia, dyspnea and so on. In the use of the process to reach the total cumulative dose, should be treated with caution to avoid the occurrence of cardiotoxicity. 7, pulmonary toxicity Some chemotherapeutic drugs can cause pulmonary toxicity, common symptoms such as dry cough, chest tightness, fever, pneumonia, pulmonary fibrosis and other pathological changes, and other serious complications. The drugs that cause pulmonary toxicity, such as bleomycin, pingyangmycin, mitomycin, neomycin, leucovorin, cyclophosphamide, tumor canning, melphalan, simustine, methylcyclic simustine, chloroethylnitrosourea, methotrexate, cytarabine, azathioprine, 6-thiopurine, periwinkle alkaloids, onychotoxin, periwinkle alkaloids, methylbenzylhydrazine, and so on. 8.Neurotoxicity