胸腔循环热灌注化疗对恶性胸腔积液的治疗效果  

Effect of Intrapleural Perfusion Hyperthermochemotherapy on Malignant Pleural Effusion

作　　者：马跃峰[1] 邢鑫[1] 杨晓平[1] 刘甜[1] 孔冉冉[1] 孙良璋[1] 李建忠[1] 姜建涛[1] MA Yue-feng;XING Xin;YANG Xiao-ping;LIU Tian;KONG Ran-ran;SUN Liang-zhang;LI Jian-zhong;JIANG Jian-tao(Department of Thoracic Surgery,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China)

机构地区：[1]西安交通大学第二附属医院胸外科

出　　处：《实用临床医学（江西）》2019年第4期43-47,共5页Practical Clinical Medicine

摘　　要：目的探讨胸腔循环热灌注化疗对恶性胸腔积液(MPE)患者的治疗效果。方法将46例MPE患者按治疗方法的不同分为2组,每组各23例。研究组予洛铂胸腔热灌注;对照组予胸穿排液后胸膜腔注入A群链球菌、洛铂。比较2组给药后药代动力学特点、近期疗效及Karnofsky生活质量评分(KPS)。结果2组患者均顺利完成治疗,未见严重并发症发生。研究组和对照组平均血浆总铂最大质量浓度分别为435.2、395.2μg·L^-1,用药后30min平均胸水总铂质量浓度分别为8103.14、7308.90μg·L^-1,胸水总铂的药时曲线下面积和血浆总铂的药时曲线下面积比分别为8.32:1、6.48:1。研究组和对照组近期有效率分别为82.6%(19/23)、43.5%(10/23),KPS总好转率分别为78.3%(18/23)、47.8%(11/23),2组比较差异有统计学意义(χ^2=7.558、P=0.006,χ^2=4.572、P=0.031);研究组和对照组不良反应发生率分别为43.5%、47.8%,2组比较差异无统计学意义(χ^2=0.807,P=0.369),经对症治疗后患者不良反应症状均得到缓解。结论胸腔循环热灌注化疗可安全、有效地控制MPE,可提高患者的近期疗效,并改善其生活质量。Objective To analyze the effect of intrapleural perfusion hyperthermochemotherapy on malignant pleural effusion(MPE). Methods Forty-six patients with MPE were divided into two groups,with 23 patients in each group.The study group was treated with intrapleural perfusion hyperthermochemotherapy with lobaplatin.The control group was given intrapleural injection of group A streptococcus and lobaplatin after chest drainage.Pharmacokinetic characteristics,short-term effect and Karnofsky Performance Status(KPS) score were compared between the two groups. Results All patients successfully completed the treatment without serious complications.The maximum concentration of total platinum in plasma was 435.2 μg·L^-1 in study group and 395.2 μg·L^-1 in control group.The average concentration of total platinum in pleural effusion was 8 103.14 μg·L^-1 in study group and 7 308.90 μg·L^-1 in control group at 30 minutes after administration.The ratio of the area under plasma concentration-time curve to the area under pleural effusion concentration-time curve was 8.32:1 in study group and 6.48:1 in control group.The short-term effective rate in study group(82.6%,19/23) was higher than that in control group( 43.5%,10/23)(χ^2 =7.558, P =0.006).Furthermore,the KPS improvement rate in study group(78.3%,18/23) was higher than that in control group(47.8%,11/23)(χ^2 =4.572, P = 0.031 ).There was no significant difference in the incidence of adverse reactions between study group( 43.5%) and control group(47.8%)(χ^2 =0.807, P =0.369).After symptomatic treatment,the symptoms were relieved in both groups. Conclusion Intrapleural perfusion hyperthermochemotherapy is a safe and effective treatment that can enhance short-term curative effect and improve the quality of life in patients with MPE.

关 键 词：胸腔热灌注化疗 恶性胸腔积液 胸膜固定 洛铂 A群链球菌 近期疗效 生活质量 

分 类 号：R734[医药卫生—肿瘤]