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1、白血病儿童化疗中严重心脏损害临床研究【摘要】目的探讨急性白血病患儿化疗中发生严重心脏损害的临床特征及预后。方法应用含蒽环类化疗药物的治疗中出现严重心脏损害的患儿8例。排除其他引起心脏损害的原因，化疗中出现以下1项异常改变：心力衰竭、心肌炎、心包炎、心源性休克。分析发生严重心脏损害发生时机、临床表现、实验室检查、治疗后转归。结果8例患儿严重心脏毒性均为亚急性，均发生心力衰竭,其中合并心包积液3例,合并心源性休克2例，合并细菌感染7例。发生时间为应用最近1次蒽环类化疗药物后5~10d。蒽环类药物累积剂量(以阿霉素计)(104．3±3
2、0．6)mg/m2。心电图均明显异常，超声心动图指标变化差异无统计学意义(P>0．05)。抢救成功4例，其中3例可耐受后续化疗。结论儿童白血病化疗中合并感染的严重心脏损害易导致急骤发生的心力衰竭，死亡率高，但抢救成功病例恢复好。蒽环类抗肿瘤药物用于儿童患者时应密切监测心电图。【关键词】蒽环类药物；心脏损害；白血病TheclinicalanalysisofseverecardiovascularcomplicationsduringchemotherapyinchildrenwithleukemiaGUOHai-xia,CHENC
3、hun,XUEHong-man,etal．DepartmentofPeadiatrics,SecondAffiliated12Hospital,SunYat-SenUniversity,Guangzhou510120，China【Abstract】ObjectiveTostudytheclinicalfeatureandprognosisonseverecardiovascularcomplicationsduringchemotherapyinchildrenwithacuteleukemia.MethodsWereporte
4、d8caseswithseverecardiovascularcomplicationsduringtreatmentcontaininganthracenenucleuschemotherapeutics.Afterexcludedotherreasonsinducingcardiovascularcomplications,abnormalchangesincludedheartfailure,myocarditis,pericarditis,cardiacshock.Opportunity,clinicalfeature,
5、laboratoryexamination,post-treatmentturnoverwereanalysed.Results8caseswereallsubacute,andhadheartfailure.Amongthem,3casesalsohadhydropericardium,2hadcardiacshock,7hadbacterialinfection.Theyhappened5~10daysafterhavinglastanthracenenucleuschemotherapeutics.Accumulatedd
6、osewas(104.3±30.6)mg/m2.Cardiogramhadsingnificantchangesandthechangesofultrasoniccardiogramhadnosignificance(P>0.05).4caseswererescued12successfully.Amongthem,3couldtolerantsuccessivechemotherapy.ConclusionChildrenwithseverecardiovascularcomplicationsduringchemothera
7、pywithinfectionoftenhavesuddenheartfailureandhavehighmortality.However,thosebeingrescuedsuccessfullyrecoverwell.Childrenpatientshavinganthracenenucleuschemotherapeuticsshouldbemonitoredwithcardiogramfrequently.【Keywords】Anthracenenucleuschemotherapeutics;Cardiovascul
8、arcomplications;Leukemia随着化疗方案的改进，儿童白血病的治疗效果有很大提高。但仍有部分患儿不能耐受强化疗对脏器的损害。心脏毒性是常见的化疗不良反应之一。同时合并的感染亦会加重对心脏的损害。因此,对儿童白血病治疗中严重心脏损害的深入理解尤其
