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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5~10 d。蒽环类药物累积剂量(以阿霉素计)(104.3±30.6)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。
Objective To investigate the clinical characteristics and prognosis of children with acute leukemia undergoing severe cardiac damage during chemotherapy. Methods Eight cases of severe heart damage were treated with anthracycline-containing chemotherapy. Exclusion of other causes of heart damage, chemotherapy, one of the following abnormalities occurred: heart failure, myocarditis, pericarditis, cardiogenic shock. Analysis of the timing of severe heart damage occurred, clinical manifestations, laboratory tests, after treatment outcome. Results Severe cardiotoxicity was subacute in all 8 children. All of them had heart failure. Among them, 3 cases had combined pericardial effusion, 2 cases had cardiogenic shock and 7 cases had bacterial infection. Occurrence time for the application of the last anthracycline chemotherapy after 5 ~ 10 d. The cumulative anthracycline dose (in doxorubicin) (104.3 ± 30.6) mg / m2. Electrocardiogram were significantly abnormal, echocardiographic parameters showed no significant difference (P> 0.05). Rescue success in 4 cases, of which 3 cases can tolerate subsequent chemotherapy. Conclusions Serious heart damage complicated by infection in childhood leukemia is easy to cause sudden heart failure. The mortality rate is high, but the successful rescue is restored. Anthracycline anti-cancer drugs should be closely monitored in children with ECG.