摘要
目的:研究24h动态心电图在监测含氟尿嘧啶(5-FU)方案治疗中晚期原发性肝癌相关心脏毒性中的效果,以提高5-FU相关性心脏毒性的防治水平。方法:将7个肿瘤中心2014年1月至2017年12月接诊的、同意使用含5-FU方案化疗的中晚期原发性肝癌患者127例,采用前瞻性非随机的方法,按患者意愿分为观察组(67例)和对照组(60例)。在每周期化疗前后,观察组用24h动态心电图监测,对照组用12导联心电图监测,结果可评价患者102例,其中观察组54例,对照组48例。对比2组心电图异常、心肌酶升高、心脏左室射血分数降低的发生率,心脏毒性的严重程度,心电图异常类型及心脏毒性的临床诊断类型。采用SPSS17.0统计学软件进行数据分析。结果:观察组和对照组的心电图异常发生率明显高于心肌酶升高、LVEF降低的发生率,差异有统计学意义。观察组总的心电图异常发生率、1~2及3~4化疗周期中心电图异常发生率、Ⅰ级心脏毒性发生率均明显高于对照组,差异有统计学意义;2组Ⅱ级、Ⅲ级、Ⅳ级心脏毒性发生率差异无统计学意义,但观察组有更轻的趋势。2组心电图异常主要表现为心律失常、ST-T改变,心脏毒性主要表现为心律失常和心肌缺血,观察组在监测方面较对照组更具优势(P<0.05)。结论:心电图异常是5-FU方案治疗中晚期原发性肝癌所致心脏毒性的主要表现,24h动态心电图比12导联心电图检测该毒性更加灵敏,能更易、更早发现心脏毒性,可代替12导联心电图进行监测。
Objective To evaluate 24-hours dynamic electrocardiogram(24 h-DCG) in determining the cardiotoxicity of fluorouracil (5-FU) on advanced primary liver cancer (PLC) patients so as to improve the prevention and treatment of 5-FU-related cardiotoxicity further. Methods A total of 127 advanced PLC patients admitted to 7 cancer centers from January 2014 to December 2017 were enrolled into the study, who were divided into an observation group(67 cases) and a control group (60 cases) with a prospective non-random method according to the wishes of patients. The observation group used 24 h-DCG and the control group used 12-lead ECG to monitor ECG abnormalities. There were 102 patients met the requirements, including 54 cases from the observation group and 48 cases of the control group. The effects of 24 h-DCG and 12-lead ECG on monitoring the incidence of ECG abnormalities,the myocardial enzyme elevation, the LVEF reduction cardiotoxicity severity, types of abnormal ECG and cardiotoxicity clinical typing also were compared. SPSS 17.0 software was used for statistical analysis. Results The incidence of ECG abnormalities was apparently higher than the myocardial enzyme elevation and the LVEF reduction in the two groups. The total incidence of ECG abnormalities, the incidence of ECG abnormalities occurring in 1-2 and 3-4 chemotherapy cycles and the incidence of Ⅰ degree cardiac toxicity of the observation group were statistically higher than those of the control group (P<0.05). The incidence of Ⅱ,Ⅲ and Ⅳ degrees cardiac toxicity of the two groups had no statistically significant difference (P>0.05), while the observation group tended to be lighter. The ECG abnormalities in the two groups were mainly manifested as arrhythmia and ST-T changes, which were clinically mainly manifested as arrhythmia and myocardial ischemia. In the detection of the two indexes, 24 h-DCG gained advantages over 12-lead ECG (P<0.05). Conclusion The ECG abnormalities is the main index of cardiotoxicity of 5-FU used in the advanced PLC patients.
作者
梁秀群
沈永奇
张青
谢华东
黄汉生
斯韬
林海永
孔祥应
LIANG Xiu-qun;SHEN Yong-qi;ZHANG Qing;XIE Hua-dong;HUANG Han-sheng;SI Tao;LIN Hai-yong;KONG Xiang-ying(Electrocardiography Department, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou 545007, Guangxi Zhuang Autonomous Region, China;Oncology Department, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou 545007, Guangxi Zhuang Autonomous Region, China;Pharmacy Department, Liujiang District People's Hospital of Liuzhou, Liuzhou 545100, Guangxi Zhuang Autonomous Region, China;Oncology Department, People's Hospital of Rongshui Miao Autonomous County, Rongshui 545300, Guangxi Zhuang Autonomous Region, China;Oncology Department, the Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou 545001,Guangxi Zhuang Autonomous Region, China;Oncology Department, the Third Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Liuzhou 545001, Guangxi Zhuang Autonomous Region, China;Oncology Department, the Second People's Hospital of Pingnan County, Pingnan 537300, Guangxi Zhuang Autonomous Region, China;Oncology Department, the Third Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Duyun 558003, Guizhou Province, China)
出处
《医疗卫生装备》
CAS
2019年第8期46-50,共5页
Chinese Medical Equipment Journal
基金
广西壮族自治区卫健委科研项目(Z20180139,Z20190448)
