胸部肿瘤调强放疗后动态心电图异常的研究.docVIP

胸部肿瘤调强放疗后动态心电图异常的研究 　　广西壮族自治区人民医院心电诊断科，广西南宁 530021 　　[摘要] 目的 探讨调强放疗（IMRT）对胸部肿瘤患者不同时间段、不同类型肿瘤、不同治疗方法动态心电图（DCG）的改变。 方法 接受IMRT的胸部肿瘤患者126例，按照肿瘤类型分为左肺癌组43例，左乳癌组39例，食管癌组44例，按照治疗方法分为单纯放疗组36例，同步放化组46例，序贯放化组44例，分别于治疗前、后，治疗结束半年后进行24 h DCG监测，比较治疗前、治疗结束时、半年后DCG异常发生率及各组治疗前后DCG异常例数。 结果 偶发房（室）性心律失常、ST-T改变在治疗后较治疗前明显增加，差异有统计学意义（χ2=6.21，P=0.013；χ2=15.14，P=0.000），两者在治疗前与治疗结束半年后比较，差异无统计学意义（P 0.05）；治疗前、后不同类型三组肿瘤、不同治疗方法三组患者比较，DCG异常发生例数差异均无统计学意义（P 0.05）。 结论 胸部肿瘤患者IMRT后DCG改变多出现在治疗早期，为可逆性的；不同类型胸部肿瘤，由于IMRT的精确性，其放疗后DCG改变相似；紫杉类+铂类化疗方案对DCG影响较小，其心脏毒性相对较低。 　　[关键词] 胸部肿瘤；调强放射治疗；动态心电图 　　[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210（2014）03（a）-0078-04 　　Study on changes of dynamic electrocardiogram in patients with thoracic neoplasm after intensity modulated radiation therapy 　　CHEN Xiaojie QIN Xiaobo ZHANG Qin YANG Suping WU Jie 　　Department of Electrocardiogram， the Peoples Hospital of Guangxi Zhuang Autonomous Region， Guangxi Zhuang Autonomous Region， Nanning 530021， China 　　[Abstract] Objective To explore the changes of dynamic electrocardiogram （DCG） at different stages， for different kinds of neoplasms and with different therapeutic methods for patients with thoracic neoplasm treated with intensity modulated radiation therapy （IMRT）. Methods 126 patients with thoracic neoplasm treated with IMRT were divided into 3 groups according to kinds of neoplasm. Among them， there were 43 patients in left lung cancer group， 39 patients in left mastocarcinoma group and 44 patients in esophageal cancer group. And according to therapeutic methods， the patients were divided into 3 groups， including radiotherapy group （n = 36）， synchronal chemoradiation group （n = 46）， and sequential chemoradiation group （n = 44）. All groups were tested with 24-hour DCG before and after treatment and half a year later to compare the abnormity incidence rates at different stages including the newly increased rates. Results Occasional atrial and ventricular premature beats， ST-T changes increased more significantly after