白血病儿童化疗中严重心脏损害的临床分析  

The clinical analysis of severe cardiovascular complications during chemotherapy in children with leukemia

作　　者：郭海霞[1] 陈纯[1] 薛红漫[1] 符少萍[1] 覃丽君[1] 周敦华[1] 黄科[1] 方建培[1] 

机构地区：[1]中山大学附属第二医院儿科,510120

出　　处：《中国实用医药》2008年第20期5-7,共3页China Practical Medicine

基　　金：中山大学医科青年教师科研启动基金(项目编号:2007011)

摘　　要：目的探讨急性白血病患儿化疗中发生严重心脏损害的临床特征及预后。方法应用含蒽环类化疗药物的治疗中出现严重心脏损害的患儿8例。排除其他引起心脏损害的原因，化疗中出现以下1项异常改变：心力衰竭、心肌炎、心包炎、心源性休克。分析发生严重心脏损害发生时机、临床表现、实验室检查、治疗后转归。结果8例患儿严重心脏毒性均为亚急性，均发生心力衰竭，其中合并心包积液3例，合并心源性休克2例，合并细菌感染7例。发生时间为应用最近1次蒽环类化疗药物后5—10d。蒽环类药物累积剂量（以阿霉素计）（104．3±30．6）mg／m^2。心电图均明显异常，超声心动图指标变化差异无统计学意义（P〉0．05）。抢救成功4例，其中3例可耐受后续化疗。结论儿童白血病化疗中合并感染的严重心脏损害易导致急骤发生的心力衰竭，死亡率高，但抢救成功病例恢复好。蒽环类抗肿瘤药物用于儿童患者时应密切监测心电图。Objective To study the clinical feature and prognosis on severe cardiovascular complications during chemotherapy in children with acute leukemia. Methods We reported 8 cases with severe cardio- vascular complications during treatment containing anthracene nucleus chemotherapeutics. After excluded other reasons inducing cardiovascular complications, abnormal changes included heart failure, myocarditis , pericarditis, cardiac shock. Opportunity, clinical feature, laboratory examination, post-treatment turnover were analysed. Results 8 cases were all subacute,and had heart failure. Among them,3cases also had hydropericardium,2 had cardiac shock,7 had bacterial infection. They happened 5 - 10 days after having last anthracene nucleus chemotherapeutics. Accumulated dose was （ 104.3 ± 30.6） mg/m^2. Cardiogram had singnificant changes and the changes of ultrasonic cardiogram had no significance （P 〉 0.05 ）. 4 cases were rescued successfully. Among them,3 could tolerant successive chemotherapy. Conclusion Children with severe cardiovascular complications during chemotherapy with infection often have sudden heart failure and have high mortality. However, those being rescued successfully recover well. Children patients having anthracene nucleus chemotherapeutics should be monitored with cardiogram frequently.

关 键 词：蒽环类药物 心脏损害 白血病 

分 类 号：R733.7[医药卫生—肿瘤]