动脉灌注化疗患者心电图改变64例分析

Electrocardiogram changes caused by arterial infusion chemotherapy:an analysis of 64 cases

目的：通过改变蒽环类抗肿瘤药物经肿瘤供养动脉给药模式的心电图观察,探讨蒽环类抗肿瘤药物的心脏毒性。方法：选择经病理学确诊的中晚期恶性肿瘤88例,化疗方案均为阿霉素＋顺铂＋氟尿嘧啶,随机分为A、B两组各44例。A组经肿瘤供养动脉主干单纯区域性灌注化疗56次;B组区域性和超选择性相结合、多靶点插管,合理灵活栓塞,小剂量用药和按血供比例灌注联合应用88次。观察2组灌注前及注药后10min、24h、48h的常规12导联心电图的变化。结果：88例患者插管前和插管时心电图均正常。经144次抗肿瘤药物灌注出现心电图改变64例,发生率为44.5%,其中A组心律失常发生率为58.1%,B组为24.2%,2组差异有统计学意义（P〈0.01）;≥60岁组心律失常的发生率高于50～59岁组（P〈0.05）。结论：经肿瘤供养动脉主干单纯区域性灌注化疗者心律失常发生率最高,提示该方法与静脉化疗阿霉素的心脏毒性作用无差异,且多发生于老年人,在介入治疗中应高度警惕。

Objective：To discuss the cardiac toxicity of anthracycline by observing the electrocardiogram which recording the routs of administration by arteries providing nutrients to the tumor.Methods：Eighty-eight cases which were pathologically diagnosed as midadvanced malignant tumor were randomly divided into group A and group B（44 cases for each group）.The chemotherapy regimen for both groups consisted of adriamycin ＋ cisplatin ＋ fluorouracil.In group A,regional perfusion through main coronary arteries of tumors was used alone for 56 times;in Group B,combined application of perfusion,regionally and super-selectively,with integration of multi-targeted intubation,reasonable and flexible embolization,low-dose of medication and perfusion according to proportion of blood supply,was conducted for 88 times.Infusion chemotherapy and embolization were conducted 144 times altogether.The conventional 12-lead ecg was recorded 10 minutes,24 hours and 48 hours after operation and drug injection.Results：Eighty-eight patients＇ electrocardiograms were normal during the process of pre-intubation and while-intubation.After conducting anticancer drug perfusion for 144 times,64 cases presented changes of electrocardiograms（44.5%）,and the incidence rate of arrhythmia was 58.1% in group A.The difference between the two groups was statistically significant（P〈0.01）.The incidence of arrhythmia in patients aged above or equal to 60 was higher than that aged between 50 and 59（P〈0.05）.Conclusions：Regarding to the two methods of interventional chemotherapy,the incidence of arrhythmia is higher in Group A.That implies that the cardiac toxicity initiated by the method used in Group A is not different from that initiated by the method of intravenous chemotherapy,and such effect occurs frequently among the elderly,which should be highly alerted to in the process of interventional chemotherapy.