晚期肺癌胸腔热灌注化疗对心脏影响的观察

Effect of the thoracic hyperthermic perfusion chemotherapy on heart in the advanced lung cancer patients

目的观察胸腔热灌注化疗对晚期肺癌患者心脏状况的影响.方法选取2014年8月至2019年8月我院病理确诊肺癌的69例胸腔热灌注化疗的患者,男性42例(60.8%),女性27例(39.8%);年龄51~79岁,中位年龄66岁.收集在胸腔热灌注化疗治疗前、治疗60 min及治疗后24h检测平均动脉压、心电图、血清脑钠肽(BNP)和肌钙蛋白(cTnT)等指标.结果22例患者出现心悸、胸闷,32例患者出现胸痛、胸闷,15例患者仅出现心悸不适,灌注化疗60 min时,症状程度最重,随后逐渐减轻.热灌注化疗治疗60 min时,血清BNP(982±205)pg/ml,化疗后24 h,血清BNP(622±225)pg/ml.患者血清BNP水平较化疗前显著增高(P<0.05).17例患者化疗期间出现窦性心动过速,16例于化疗后24 h恢复窦律,1例48 h后恢复窦律(P<0.05).28例患者化疗期间发生ST-T段改变,27例于化疗后24 h恢复正常,有1例48 h后恢复正常(P均<0.05).灌注化疗期间未观察到明显房(室)性心律失常和房室传导阻滞发生,患者平均动脉压和cTnT无明显变化(P>0.05),亦无严重的心血管事件发生.结论对晚期肺癌患者应用胸腔热灌注化疗,不会对心脏造成较大的损伤,但应该对患者做好心脏功能评估和预防措施.

Objective To observe the effect of thoracic thermal perfusion chemotherapy on heart on in the patients with advanced lung cancer.Methods From August 2014 to August 2019,69 patients with thoracic thermal perfusion chemotherapy who were pathologically diagnosed with lung cancer were selected,including 42 males(60.8%)and 27 females(39.8%).The age was 51-79 years old and the median age was 66 years old.The mean arterial pressure,electrocardiogram(ECG),serum brain natriuretic peptide(BNP)and cTnT were measured before treatment,treatment for 60 minutes and 24 hours after treatment.Results 22 patients had palpitations and chest distress,32 patients had chest pain and chest distress and 15 patients only had palpitations and discomfort.The most serious symptoms appeared at 60 min of infusion chemotherapy and then gradually alleviated.After 60 min of the infusion chemotherapy,the serum BNP was(982±205)pg/ml and it was(622±225)pg/ml 24 hours after the heart infusion chemotheray.The serum BNP level of the patients was significantly higher than that before chemotherapy(P<0.05).Sinus tachycardia appeared during chemotherapy in 17 patients,of whom 16 resumed sinus rhythm after 24 hours of the chemotherapy and 1 patient resumed sinus rhythm after 48 hours of the chemotherapy(P<0.05).In 28 patients,ST-T segment changes occurred during the chemotherapy,of whom 27 patients returned to normal 24 hours after the chemotherapy and l patient returned to normal after the chemotherapy of 48 hours(P<0.05).Atrial(ventricular)arrhythmia and atrioventricular block were not observed during the perfusion chemotherapy;no significant changes were observed in the patients'mean arterial pressure and cTnT(P>0.05);no serious cardiovascular events occurred.Conclusion It indicates that the treatment dose not cause major damage to the heart when the patients treated with thoracic thermal perfusion chemotherapy.However,the functional changes of the heart should be evaluated and the precautions should be taken during the treatment.