恶性肿瘤患者化疗前后心电图变化分析

Changes in electrocardiogram in patients with malignant tumors before and after chemotherapy

目的探讨恶性肿瘤患者化疗前后体表心电图的改变。方法选取2014年6月至2017年2月间汉阳医院和同济医院收治的700例恶性肿瘤患者,对恶性肿瘤患者采用不同化疗方案(蒽环类和非蒽环类)治疗前后12导联心电图的变化情况进行分析。结果蒽环类化疗方案患者心电图异常发生率为62.0%,明显高于不含蒽环类化疗方案患者的8.2%,差异有统计学意义(P<0.05)。两组患者化疗后Q-Tc间期比化疗前均明显延长,且含蒽环方案患者延长更明显,差异均有统计学意义(均P<0.05)。两组患者化疗后的全部窦性心搏RR间期(SDNN)、24h每5min窦性心搏R-R间期平均值标准差(SDANN)、全部相邻窦性R-R间期差值均方根(RMSSD)、相邻窦性R-R间期差值>50ms心搏数占窦性R-R间期总搏数百分比(p NN50)均比化疗前降低,且含蒽环方案患者降低更明显,差异均有统计学意义(均P<0.05)。结论各种化疗方案均可能产生心脏毒性,含蒽环类化疗方案尤为明显。

Objective To study the changes in body surface electrocardiogram（ ECG） in patients with malignant tumors before and after chemotherapy. Methods Seven hundred patients with malignant tumors treated at Hanyang Hospital Affiliated to Wuhan University of Science and Technology from June2014 to February 2017 were selected. Changes in standard 12 lead ECG in patients with different chemotherapy regimens（ anthracycline and non-anthracycline） were analyzed before and after the treatment.Results Incidence of low voltage of R wave ECG,flat voltage of T wave and ST segment depression was 62. 0% in patients receiving chemotherapy containing anthracycline which was significantly higher than 8. 2% in patients receiving non-anthracycline containing chemotherapy. QTc interval was significantly prolonged in both groups after chemotherapy compared with before chemotherapy with anthracycline chemotherapy group better than non-anthracycline chemotherapy group（ all P〈0. 05）. Standard deviation of all normal to normal intervals（ SDNN）,24 h standard deviation of 5 min average normal RR intervals（ SDANN）,square root of the mean of the squared differences between adjacent normal RR intervals（ RMSSD） and percentage of differences exceeding 50 ms between adjacent normal number of intervals（ p NN50） decreased in both groups after chemotherapy with the reduction more obvious in anthracycline containing chemotherapy than non-anthracycline containing chemotherapy（ all P〈0. 05）. Conclusion All kinds of chemotherapy may cause cardiotoxicity especially for anthracycline chemotherapy.