超声心动图联合心电图评估非小细胞肺癌放化疗后患者心脏损伤的应用研究  

Application of echocardiogram combined with electrocardiogram in reviewing cardiac injury in patients with non-small cell lung cancer after chemoradiotherapy

作　　者：陈建梅[1] 刘禧 郝媛媛 刘洋[1] 全艳 于爱军 Chen Jianmei;Liu Xi;Hao Yuanyuan;Liu Yang;Quan Yan;Yu Aijun(Department of Cardiology,First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一附属医院心内科

出　　处：《中国循证心血管医学杂志》2019年第11期1362-1365,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：解放军总医院科技创新苗圃基金(14KMM26)

摘　　要：目的研究超声心动图联合心电图对非小细胞肺癌放化疗后患者心脏损伤的评估应用,为临床治疗提供有效依据。方法选择2016年1月至2017年6月于解放军总医院第一附属医院收治的145例非小细胞肺癌放化疗患者作为研究对象,在对患者进行放化疗后采用超声心动图联合心电图对患者进行检查分析,对心脏的心电图和超声心动图结果进行分析,比较治疗后的患者两种检验方法的心脏损伤的检出情况。结果患者在接受放化疗治疗2周后,患者心电图指标HR、QTc(83.15±14.19次/min、439.75±21.55 ms)明显高于放化疗治疗前(74.38±11.05次/min、414.47±19.54 ms,P<0.05),而QRS波幅、T波幅(2.18±0.44 mV、0.32±0.10 mV)明显低于治疗前(1.86±0.21 mV、0.24±0.03 mV,P<0.05)。患者超声心动图指标左室射血分数(LVEF)、左心室短轴缩短率(FS)、脉冲式多普勒超声检测指标包括左房室瓣舒张早期最大峰值速度(E峰)、舒张晚期最大峰值速度(A峰)、E/A比值(61.08±4.19%、34.25±4.01%、66.98±14.28%、0.91±0.16)明显低于放化疗治疗前(67.98±4.89%、37.83±4.32%、74.67±21.06%、1.24±0.30,P<0.05)。采用超声心动图和心电图对患者的心脏损伤进行检测,发现超声心动图与心电图检查对于心肌炎、心律失常、冠脉事件的检出率比较无明显差异(58.82%、57.14%、63.41%;58.82%、33.33%、75.61%,P>0.05);超声心动图对于瓣膜疾病的检出率(83.87%)明显高于心电图检查(66.13%,P<0.05),而心电图检查对于传导系统损伤及心肌缺血或损伤的检出率(93.24%、93.55%)明显高于超声心动图检查(71.62%、69.35%,P<0.05),联合检查对于放射性心脏损伤疾病(本研究中指心肌炎、心律失常、冠脉事件、瓣膜疾病、传导系统损伤及心肌缺血或损伤)的检出率(88.23%、83.33%、97.56%、96.77%、97.29%、98.38%)明显高于单独采用超声心动图或心电图检查(P均<0.05)。结论在进行放化疗之后,患者的心功能发�Objective To study the application of echocardiogram combined with electrocardiogram(ECG)in reviewing cardiac injury in patients with non-small cell lung cancer(NSCLC)after chemoradiotherapy,and provide effective evidence for clinical treatment.Methods NSCLC patients(n=145)were chosen from the First Affiliated Hospital of Chinese PLA General Hospital from Jan.2016 to June 2017.After chemoradiotherapy,all patients were given examinations of echocardiogram combined with ECG.The results of ECG and echocardiogram were analyzed,and detection of cardiac injury were compared between echocardiogram and ECG.Results After treatment for 2 weeks,HR and QTc in ECG(83.15±14.19 time/min,439.75±21.55 ms)were significantly higher than those before treatment(74.38±11.05 time/min,414.47±19.54 ms,P<0.05),and QRS wave amplitude and T wave amplitude in ECG(2.18±0.44 mV,0.32±0.10 mV)were significantly lower than those before treatment(1.86±0.21 mV,0.24±0.03 mV,P<0.05).The indexes of echocardiogram in including left ventricular ejection fraction(LVEF)and left ventricular fraction shortening(LVFS),indexes of pulsed Doppler ultrasound detection including left atrioventricular valve early-diastolic maximum peak velocity(peak E),late-diastolic maximum peak velocity(peak A)and E/A ratio were significantly lower(61.08±4.19%,34.25±4.01%,66.98±14.28%,0.91±0.16)after treatment than those before treatment(67.98±4.89%,37.83±4.32%,74.67±21.06%,1.24±0.30,P<0.05).There were no significant differences in the detection rates of myocarditis,arrhythmia and coronary events between echocardiogram and ECG(58.82%,57.14%,63.41%;58.82%,33.33%,75.61%,P>0.05).The detection rate of valvular disease by echocardiogram(83.87%)was significantly higher than that by ECG(66.13%,P<0.05),and detection rates of conduction system injury and myocardial ischemia or injury by ECG(93.24%,93.55%)were significantly higher than those by echocardiogram(71.62%,69.35%,P<0.05).The detection rates of radioactive heart disease(myocarditis,arrhythmia,coronary events,valvu

关 键 词：超声心动图 心电图 非小细胞肺癌 心脏损伤 

分 类 号：R540.45[医药卫生—心血管疾病]