表阿霉素微量泵入与静脉滴注不良反应观察

Toxic Side-effects of Micro-pump and Intravenous Drip of Epirubicin

目的观察表阿霉素微量泵入与静脉滴注的不良反应。方法将病理确诊的46例乳腺癌和19例淋巴瘤患者随机分成两组,微量泵入组31例,静脉滴注组34例,表阿霉素剂量为70mg/m2;每周期治疗前后检测血常规、心肌酶、心电图和口腔黏膜,以观察两种不同给药方法对患者骨髓、心脏和口腔黏膜的影响。结果微量泵入组第9～13天白细胞下降至最低,Ⅳ度骨髓抑制率为22.5%;静脉滴注组第7～9天白细胞下降至最低,Ⅳ度骨髓抑制率为8.8%;两组间比较差异有统计学意义。心肌酶在两组中化疗后较化疗前升高,静脉滴注组差异有统计学意义,但无临床意义;微量泵入组化疗前后差异既无统计学意义,也无临床意义。心电图在微量泵入组中化疗四周期后80%出现ST-T改变;静脉滴注组中化疗三周期后90%出现ST-T改变,其中20%(7/34)在静脉滴注过程中出现心悸、胸闷、心前区不适、心率增快(10～20)次/分。口腔黏膜炎在微量泵入组4人出现,占12.9%(4/31),静脉滴注组1人出现2.9%(1/34)。结论表阿霉素微量泵入能减轻心脏的毒性,但骨髓抑制出现时间后移,Ⅳ度骨髓抑制率及口腔黏膜炎发生率升高。

Objective To compare the toxic side-effects of Micro-pump and Intravenous Drip of Epirubicin.Methods Sixty-five cases were chosen for the study,with 46 cases with breast cancer and 19 with malignant lymphoma,and they were divided at random into two groups：Micro-pump group（n=31） and Intravenous Drip（n=34）.The two groups were given the same dose of Epirubicin（70 mg/m2）.Routine tests of blood,myocardial enzyme and electrocardiograms were detected before and after each chemotherapy.Results Nine to eleven days after the chemotherapy,the number of leukocytes had dropped to the lowest level and the Ⅳ marrow constraint rate was 22.5% in the micro-pump group.In contrast,the number of leukocytes reaches its lowest level seven to nine days after the chemotherapy in the Intravenous Drip group and the IV marrow constraint rate was 8.8%.There was statistic significance.Although the number of myocardial enzyme was increased in both groups after the chemotherapy,results of the Intravenous Drip group were statistic,but not clinical significance.Results of the micro-pump group yield neither statistic nor clinical significance.According to electrocardiograms,after four courses of chemotherapy,ST-T change had taken place in 80% cases of the micro-pump group,whereas 90% in Intravenous Drip groups was ST-T change after three courses of chemotherapy and 20% of the cases（7/34） had symptoms such as palpitation,chest distress,precordial distress and an increase of heart rate by 10 to 20 beatsper minute.In addition,four cases were found suffering oral mucitis in the micro-pump group,accounting for 12.9%（4/31）,whereas only one case was found with the same symptom in the Intravenous Drip group.Conclusion Micro-pump of Epirubicin is likely to reduce the toxic-effects of Epirubicin on heart,but may postpone its constraint on marrow,and lead to a higher frequency of the IV marrow constraint and oral mucitis.