超声心动图检查评价胸部放疗致肿瘤病人心脏损害的临床价值.doc

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1、超声心动图检查评价胸部放疗致肿瘤病人心脏损害的临床价值【摘要】目的探讨常规超声心动图检查评价胸部放疗致心脏损害的临床价值。方法120例放疗病人依据是否联合化疗及化疗剂种类分为单纯放疗组（I组），放疗联合蔥环类化疗组（II组），放疗联合其他化疗剂组（III组）。测定并比较120例胸部肿瘤病人放疗前和放疗后6个月的常规超声心动图参数。结果与放疗前相比，放疗后15例病人（12.5%）常规超声心动图检查示心脏结构和血流动力学参数异常，其中心包积液7例，量少至中；心包壁增厚2例；瓣膜形态改变及反流6例，其中主动脉瓣反流3例，二尖瓣反流2例，主动脉瓣及二、三尖瓣均有反流1例，为轻、中度反流；此15例

2、病人屮9例为放疗联合葱环类化疗。34例（28.3%）病人放疗后出现一项或多项左心室舒张功能指标异常（E/A<1、DT或IVRT延长）；12例（10.0%）病人放疗后出现常规右心室舒张功能指标异常。出现肺动脉高压2例。但左心室收缩功能参数和室间隔（IVS）及左心室后壁（LVPW）的室壁增厚率（AT%）在放疗前后差异无显著性。结论常规超声心动图可评价放疗所致的心脏结构、功能和血流动力学参数异常。心脏舒张功能比收缩功能更易受辐射影响，且放疗联合化疗可加重心脏损害，尤以联合恿环类化疗剂为重。【关键词】超声心动描记术多普勒放射疗法胸部肿瘤心脏损[ABSTRACT]Object!veToeva

3、luatethesignificanceofechocardiographyinassessingheartdamagecausedbychestradiotherapy.MethodsPatientsreceivedthoracicradiationtherapy(n=120)weredividedintothreegroups:thosereceivingradiotherapyonlyasgroupI;thosereceivingradiotherapytogetherwithanthracyclinesasgroupII;andthosereceivingradiotherapy

4、togetherwithotherchemotherapeuticsasgroup1TLEchocardiographywasperformedsixmonthslaterafterthechestradiotherapy,andtheresultsobtainedwerecomparedwiththatbeforethechestradiotherapy.ResultsAbnormalfindingsappearedin15patientsafterradiation(12・5%),whichineludedmildtomoderatepericardialeffusion(7pati

5、ents),thickeningofpericardialwal1(2),deformedheartvalveswithmiIdtomoderatevalvularregurgitationinsixpatients,inwhich,aorticvalve(3patients),mitral(2),andaorticvalvecomplicatedwithmitralandtricuspidvalves(1).Oftheseabnormalities,ninepatientswerefoundingroupII.Regressionofdiastolicfunctionofleftven

6、tricleappearedin34patients(28.3%)andabnormalitiesofroutinediastolicfunctionindexofrightventricleappearedin12patients(10.0%)・Hypertensionofpulmonaryarteryduringsystolicphaseappearedintwopatients・Parametersofleftventriclesystolicfunctionafterradiotherapydidnotchangesignificantlycomparedwiththosebef

7、oreradiotherapy.ConclusionEchocardiographycanbeusedinassessingtheheartdamagecausedbychestradiotherapy.Comparedwithsystolicfunction,diastolicfunctionismoreeasilyaffected.Radiotherapycombinedwithchemotherapycanaggravatet