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目的:观察引流心包积液后,行卡铂联合白介素-2腔内注射治疗恶性心包积液的疗效及安全性。方法:收集53例恶性心包积液患者,先用中心静脉导管行经皮穿刺心包置管引流,待积液基本引尽后,随机抽取12例(卡铂组)经导管注入卡铂300 mg,13例(白介素组)注入白介素-2 200万U,28例(联合治疗组)同时注入卡铂300 mg和白介素-2 200万U,保留48 h后抽净积液,拔管,并作随访。结果:所有患者经治疗后,卡铂组完全缓解(complete response,CR)5例(41.7%),部分缓解(partial response,PR)3例(25.0%),无效(no change,NC)4例(33.3%),总有效率66.7%;白介素组CR 4例(30.8%),PR 4例(30.8%),NC 5例(38.4%),总有效率61.6%;联合治疗组CR 18例(64.3%),PR 9例(32.1%),NC 1例(3.6%),总有效率96.4%。无1例发生穿刺意外;卡铂组1例(8.3%)、联合治疗组2例(7.1%)出现轻度恶心、胃纳轻度减低,胃复安、维生素B6对症治疗后短期好转,白介素组无胃肠反应发生;白介素组2例(15.4%)、联合治疗组5例(17.9%)出现轻度胸痛和低热,用新癀片或吲哚美辛栓剂可控制,卡铂组无胸痛、发热表现;随访2周,无1例发生骨髓抑制;随访3月,无1例发生缩窄性心包炎。结论:卡铂联合白介素-2治疗恶性心包积液安全、有效,值得临床推广应用。
Objective: To observe the curative effect and safety of pericardial effusion combined with carboplatin and interleukin-2 in the treatment of malignant pericardial effusion. Methods: Fifty-three patients with malignant pericardial effusion were collected. The patients were firstly perfused with pericardium by central venous catheter and perfused by pericardiocentesis. After the basic fluid was drained, 12 patients (carboplatin group) were randomly injected with carboplatin 300 mg, 13 Cases (interleukin group) injected interleukin -2 200 million U, 28 patients (combination therapy group) while injecting carboplatin 300 mg and interleukin -2 million U, 48 h retention net withdrawal fluid, extubation, and for follow-up. Results: After treatment, 5 patients (41.7%) had complete response (CR), 3 patients (25.0%) had partial response (PR), 4 patients had no change (NC) (33.3%), the total effective rate was 66.7%. In the interleukin group, 4 cases (30.8%) of CR, 4 cases of PR (30.8%), 5 cases of NC (38.4%), the total effective rate was 61.6% 64.3%), PR 9 cases (32.1%), NC 1 case (3.6%), the total efficiency of 96.4%. 1 case (8.3%) in carboplatin group and 2 cases (7.1%) in combination therapy group had mild nausea and mild gastric insufficiency, and metformin and vitamin B6 had a short-term improvement after symptomatic treatment. Interleukin Group had no gastrointestinal reaction; 2 cases (15.4%) in the interleukin group and 5 cases (17.9%) in the combined treatment group had mild chest pain and fever, with Xinwan tablets or indometacin suppositories, carboplatin group had no chest pain , Fever; follow-up 2 weeks, no case of bone marrow suppression occurred; follow-up of 3 months, no case of constrictive pericarditis occurred. Conclusion: Carboplatin combined with interleukin-2 in the treatment of malignant pericardial effusion is safe and effective, which is worthy of clinical application.