超声引导下恶性心包积液置管引流并腔内化疗临床价值

Ultrasound-guided pericardiocentesis and transcatheter drug therapy as treatment for malignant pericardial effusion

目的探讨超声引导下恶性心包积液置管引流并腔内化疗的临床价值。方法选择自2012年1月至2017年5月沈阳军区总医院收治的60例恶性病患者为研究对象,超声引导下进行心包积液置管引流。当无心包积液引出时,经导管向心包腔注入化疗药物,比较患者引流前后的左室射血分数(LVEF)和左室短轴缩短率(LVFS)及二尖瓣口舒张早、晚期血流速度峰值(E峰、A峰),计算E/A值,及引流后与腔内化疗后的左心舒张功能,进行疗效评价。结果 60例患者中,完全缓解占66.7%(40/60),部分缓解占23.3%(14/60),进展占6.7%(4/60),死亡占3.3%(2/60),有效率90.0%(54/60)。引流结束时与引流前比较,患者的LVFS、LVEF明显升高,差异有统计学意义(P<0.05),左心舒张功能正常的患者数量略有提高,差异无统计学意义(P>0.05)。40例完全缓解患者中,引流结束后左心舒张功能恢复正常占5.0%(2/40),腔内化疗后增至72.5%(29/40),差异有统计学意义(P<0.05)。结论超声引导经心尖全程实时心包腔置管引流恶性心包积液安全有效,可以及时改善患者的左心收缩功能,同时进行腔内化疗,有利于左心舒张功能的恢复。

Objective To investigate the clinic value of ultrasound-guided pericardiocentesis and transcatheter drug therapy as treatment for malignant pericardial effusion. Methods A retrospective study was performed on 60 cases of patients with malignant pericardial effusion who were admitted from January 2012 to May 2017. Patients were performed ultrasound-guided pericardiocentesis. Transcatheter drug therapy was performed when the effusion disappeared,comparison of patients before and after drainage of left ventricular ejection fraction（ LVEF）,left ventricular short axis shortening rate（ LVFS）,mitral valve mouth early and late diastolic blood flow velocity E peak,A peak,E/A value was calculated,and drainage with cavity chemotherapy after left cardiac diastolic function were observed to compare the curative effect. Results Among the 60 patients,the total remission accounted for 66. 7%（ 40/60）,the partial mitigation accounted for 23. 3%（ 14/60）,the progress accounted for 6. 7%（ 4/60）,the death rate was 3. 3%（ 2/60） and the effective rate was 90. 0%（ 56/60）. At the end of drainage,LVFS and LVEF increased significantly compared than those before the operation（ P 〈 0. 05）; left diastolic function in patients with normal quantity slightly increased,there was no statistically significant difference（ P 〉 0. 05）. In the 40 patients with total remission,the left heart diastolic function returned to normal at 5. 0%（ 2/40） after the drainage,and increased to 72. 5%（ 29/40） after chemotherapy（ P 〈 0. 05）. Conclusion Ultrasound-guided pericardiocentesis as treatment for malignant pericardial effusion is safe and reliable,which can improve left heart of function of contraction. Transcatheter drug therapy can reduce recurrence of pericardial effusion,which is in favor of improvement of left heart of diastolic function.