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癌症化疗引起的心脏毒性

2012-03-05 18:47 作者: 来源: 本站 浏览: 1,348 次 我要评论(12条) 字号:

摘要: 很多化疗药都具有分歧水平的心脏毒性。如蒽环类抗生素(阿霉素、柔红霉素)、甲氨蝶呤、环磷酰胺、氟尿嘧啶、博莱霉素、阿糖胞苷、丝裂霉素、长春新碱类。个中毒性最分明、最经常见的是阿霉素,其对心肌有较高的选择性和急性毒性。阿霉素的心脏毒性与累积量有关c剂量大于550m...

很多化疗药都具有分歧水平的心脏毒性。如蒽环类抗生素(阿霉素、柔红霉素)、甲氨蝶呤、环磷酰胺、氟尿嘧啶、博莱霉素、阿糖胞苷、丝裂霉素、长春新碱类。个中毒性最分明、最经常见的是阿霉素,其对心肌有较高的选择性和急性毒性。阿霉素的心脏毒性与累积量有关c剂量大于550mg/m2,心脏毒性分明高,660Ⅱig/m2时,发作率达30%。其心脏毒性改动,肺癌晚期  首要为心电图异常,如心动过速、期前缩短、S-T升高或降低、心律不齐、T波异常,约有10% – 25%会发作,可天然恢复;一为推迟性进行性心脏损害,显示为急性充血性心力弱竭,发作率为2% – 30%,较难逆转,预后较差,灭亡率高。
别的,大剂量环磷酰胺120 – 240mg/kg,也可惹起心脏毒性,用药后2周左右,呈现急性或亚急性心力弱竭;氟尿嘧啶可惹起心绞痛;顺铂、马利兰和丝裂霉素也可呈现心肌毁伤。
(1)心脏毁伤的西医防治:
①节制阿霉素等药的用量。阿霉素总量以不超越550mg/m:为宜。有前提者可换用表阿霉素。使用阿霉素,每周作心电图反省1次,化疗后6个月内,按期复查心电图,还可口服维生素E 20mg,每日2-3次;辅酶Q10 lOmg,每日3次;维拉帕米(异搏定)40mg,每日3次。需要时静脉使用心肌激化液维护心脏。

②心脏毒性反响的处置为:停药、卧床歇息、利尿和运用心血管活性药物、抗心律变态药物。在阿霉素总量不变的状况下, 肺癌治疗   可改三周给药为每周给药一次,以削减阿霉素的心脏毒性,也可经过48小时或96小时延续静滴的办法削减阿霉素的心脏毒性,还还可削减消化道反响。
③渗出性心包炎以心包穿刺引流为主,缩窄性心包炎则采专心包松解术。
(2)心脏毒性的中医防治:
使用阿霉素时,可用生脉饮1支,口服,每日2次;冠心苏合丸3-5粒,口服,每日3次。   肺癌中医  静脉用药可滴注参麦打针液20ml或复方丹参打针液lOmg。中药汤剂以益气养阴,宽胸理气,活血为主,可用五参饮:党参lOg,太子参15g,沙参15g,丹参
15g,苦参12g,五味子IOg,麦冬I5g,葛根18g,川芎1Og,另加瓜蒌18g。

本文由 http://www.cm99.cn/ 整理并发布!

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