摘要
目的：前瞻性观察大剂量５－氟尿嘧啶（５－ＦＵ）化疗对心脏的毒性。方法：收集恶性滋养细胞肿瘤患者１０４例，共行化疗１９２疗程。其中，５－ＦＵ单药化疗７１疗程，５－ＦＵ加更生霉素（ＫＳＭ）联合化疗１０９疗程，ＫＳＭ单药化疗１２疗程。５－ＦＵ用法：单药化疗，每日２８～３０ｍｇ／ｋｇ；联合化疗，每日２４～２６ｍｇ／ｋｇ；加入５００ｍｌ５％葡萄糖液中，缓慢匀速静脉滴注８小时。于化疗前后分别观察并计算与心脏损害有关的临床症状、心电图异常及心肌酶谱改变等发生率。结果：１９２疗程中，化疗后有１４例１４疗程中出现心慌、心悸、胸闷等症状。８例８疗程中心电图出现ＳＴ段或Ｔ波改变，２例３疗程出现窦性心动过速。心肌酶谱变化为升高、下降或无改变不等。将上述３项指标中出现两项异常作为心脏损害的诊断标准，则５－ＦＵ组的发生率为４．２％，５－ＦＵ＋ＫＳＭ组为４．６％，ＫＳＭ组为０％。对出现的症状不需特殊处理，停化疗后可自行消失，在继续化疗中不重复出现。７例化疗前即有心脏异常的患者，５－ＦＵ化疗后未出现明显的心脏损害加重。结论：大剂量５－ＦＵ化疗后可能出现轻度的心脏损害。但症状轻微，具有可恢复性。需要强调严格掌握５－ＦＵ剂量，缓慢匀速静脉滴注?
Objective:Todeterminethepossibilityandmagnitudeofcardiotoxicityfolowinghighdoseintravenousinfusionoffluorouracil(5-FU).Methods:Aprospectiveclinicalstudywasperformedon104patientswithchoriocarcinomaandinvasivemole.5-FUwasadministeredbyslowintravenousinfusionin5%glucose500mlfor8hoursatdosesof28～30mg·kg-1·day-1whenusedasasingleagenttreatmentor24～26mg·kg-1·day-1whenusedincombinationwithkengshengmycin(KSM).Thetotalcyclesoftreatmentwith5-FU+KSMwere109andthoseof5-FUorKSMeachusedasasingleagentwere71and12respectively.Thecardiacfunctionsweremonitoredbycardiacsymptoms,ECGandserumcardiacenzymesbeforeandafter5-FUinfusion.Results:Amongthe192treatmentcyclestachycardia,palpitationorcardiacdistreswereobservedin14cycles.ECGshowedchangesofSTorTwavesin8cycles,sinustachycardiain3cycles.Theresultsofserumcardiacenzymedeterminationswerevariable.Thediagnosticcriteriaofcardiotoxicitywereappearancesofabnormalitiesmanifestedinanytwoofthethreemonitoritems.Theincidenceofcardiotoxicitywas4.2%in5-FUgroup,4.6%in5-FU+KSMgroupand0%inKSMgroup.Alepisodesweremild,reversiblespontaneouslyaftercessationofchemotherapyanddidnotreappearinsubsequentchemotherapeuticcycles.Sevenpatientswithdefinitecardiacdiseasesbeforechemotherapyweregiven5-FUtreatment,butnoobviousaggravationofcardio-toxicitieswereobservedevenwithrepeated5-FUtreatments.Conclusion:Onlyocasionalcardiotoxiciteswereobservedin5-FUtreatments.Theywererathermildandreversible.Theincidenceofcardiotoxicitymightbereducedwithemphasisonstrictobservanceofthetreatmentregimeninregardtothedosageused,thespeedoftheinfusionandatentiontothetreatmentofanyside-efects.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
1996年第2期86-89,共4页
Chinese Journal of Obstetrics and Gynecology
