奈达铂与顺铂胸腔热灌注疗法治疗肺癌恶性胸腔积液疗效评价及风险评估.pdf

目 录 摘要 ··························································································· 1 Abstract ······················································································· 3 前言 ··························································································· 5 材料与方法 ·················································································· 7 结果 ························································································ 10 讨论 ························································································ 13 结论 ························································································· 15 参考文献 ··················································································· 16 综述： ······················································································ 21 攻读学位期间发表文章情况 ··························································· 39 致谢 ························································································· 41 个人简历 ··················································································· 42 奈达铂与顺铂胸腔热灌注疗法治疗肺癌恶性胸腔积液疗效评价 及风险评估 摘 要 背景 肺癌是我国高发的恶性肿瘤，目前肺癌的首选治疗方案仍然是手术治疗。由于经 济、医疗条件的限制，大部分肺癌患者确诊后已经是局部晚期或是转移导致恶性胸腔 积液，已无法手术治疗。恶性胸腔积液，大多是胸腔积液中发现恶性细胞。目前治疗 恶性胸腔积液的方法主要推荐胸腔闭式引流术、胸膜固定术、热灌注化学药物等治疗 为主。胸腔热灌注化疗可以作用于局部，减轻化疗药物的毒副作用，已经成为临床常 用的治疗方法。 目的 探讨奈达铂与顺铂胸腔热灌注疗法治疗肺癌恶性胸腔积液疗效评价及风险评估 方法 入选 2017 年 4 月～2018 年 12 月新乡医学院第一附属医院胸外科肺癌合并恶性 胸腔积液患者，根据严格的纳排标准，最终纳入 58 例肺癌恶性胸腔积液。采用随机 数字表的方法分成 NR 组（29 例）、FR 组（29 例）：NR 组接受奈达铂（40mg/㎡） 灌注液4000ml ，温度设置45 ℃进行胸腔热灌注化学治疗60min；FR 组接受顺铂（40mg/ ㎡）灌注液 4000ml ，温度设置 45 ℃进行胸腔热灌注化学治疗 60min，治疗结束后， 每 4 周进行一次随访。本研究旨在比较奈达铂和顺铂胸腔热灌注化疗治疗效果、不良 反应以及治疗前后血小板数量、白蛋白/球蛋白比值、白细胞数量、血红蛋白、AST 、 ALT 。 1 结果 NR 组治疗效果、KPS 分值、骨髓抑制、肝肾损害、血小板、白蛋白/球蛋白比值、 白细胞、血红蛋白、AST 、ALT 与 FR 组均