白血病患者化疗相关心脏毒性的监测与分析

Monitoring and Analysis of Cardiotoxicity Related to Chemotherapeutics in Leukemia Patients

目的:探究不同类型白血病患者化疗后的心电图表现,为防治与化疗药物相关的心脏毒性提供依据。方法:统计分析209例急性白血病患者化疗前期、诱导缓解期、强化巩固期的心电图结果,对30例慢性白血病患者化疗前、后的心电图结果进行对比分析。结果:化疗后的心电图异常改变以ST-T改变、窦性心动过速、左心室高电压、期前收缩、传导阻滞多见。强化巩固期的心电图异常率最高,与诱导缓解期、化疗前期比较差异均具有统计学意义(P<0.05)。急性淋巴细胞白血病(ALL)组与急性非淋巴白血病(AML)组之间及其二者的各亚型之间心电图异常率在同一化疗时期无显著差异(P>0.05)。慢性白血病患者心电图异常率在化疗后升高。结论:白血病化疗药物会造成严重的心脏毒性,化疗过程中应严密监测患者心电图,以便及早发现心肌的损伤并采用保护心肌的措施。

Objective：To investigate electrocardiogram（ECG） finding about leukemia with different types after chemotherapy, so as to provide scientific evidences for prevention and treatment of cardiotoxicity associated with chemotherapeuties in the future. Methods： ECG results concering acute leukemia during different phase of chemotherapy in 209 patients were summarized and analyzed, to analyze ECG re- sults related to chronic leukima in 30 patients before and after chemotherapy. Results： ST-T change, sinus tachycardia,left ventricular high voltage, premature and conduction block are more common abnormal ECG change in patient with leukemia after chemothera- py. Consolidation phase present the highest rate of abnormal ECG, and the rate shows statistical significance in comparasion with other two phases in acute leukemia（P 〈 0. 05 ）. Nevertheless the difference between the acute ｜ymphoblastic leukemia（ALL） and the acute myeloge- nous leukemia（AML） is in distinctive（P 〉 0. 05 ） ,and it is the same in their each type （P 〉 0. 05 ）. The abnormal ECG rate of patients with chronic leukemia will improve after chemotherapy. Conclusion： Chemotherapentics can lead to severe cardiotoxicity so that frequent monitoring of ECG change should be instituted during chemotherapy treatment in patient with leukemia, in order to discover myocardical damage as well as measures of myocardical protection should be taken before it is too late.