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目的:研究胸部肿瘤放疗合并化疗后的心电图改变的原因及临床预防措施。方法:选择入院时心电图正常的胸部肿瘤放疗合并化疗后出现心电图异常并且半年后随访有心电图记载的242例患者(肺癌125例,食管癌94例,淋巴瘤23例),所有病例均采用常规分割法放疗,总量5500～6500CGy,并根据病情选择适宜的化疗方案,如 CAP、CHOP 等。记录病人放化疗结束时以及半年后心电图资料对照分析。结果:放疗合并化疗结束时 ST-T 改变171例;半年后窦房结病变22例(慢性房颤12例、窦缓9例、窦性停搏1例)。结论:放疗合并化疗对心脏的损伤主要是对心肌、血管及心包的损伤。放疗合并化疗结束时的损伤为急性期损伤,主要累及心肌及心包,表现为 ST-T 改变,半年后主要是窦房结病变;急性期损伤多数可修复而慢性期损伤多数不易修复,要求放疗时尽可能缩野并避开右心房,同时定期复查心电图,早发现、早治疗。
Objective: To study the causes of electrocardiogram changes after thoracic tumor radiotherapy combined with chemotherapy and its clinical preventive measures. Methods: Electrocardiogram abnormalities were observed after radiotherapy combined with chemotherapy in patients with normal chest electrocardiogram at admission. There were 242 patients (125 lung cancer, 94 esophageal cancer and 23 lymphoma) followed up by electrocardiogram after 6 months. All the patients were divided by conventional method Radiation therapy, the total amount of 5500 ~ 6500CGy, and choose the appropriate chemotherapy based on the disease program, such as CAP, CHOP and so on. Record patients at the end of chemotherapy and electrocardiogram after six months control analysis. Results: ST-T changed 171 cases at the end of radiotherapy combined chemotherapy. In six months, 22 cases of sinus node disease (12 cases of chronic atrial fibrillation, 9 cases of sinus delay and 1 case of sinus arrest). Conclusion: Radiotherapy combined with chemotherapy mainly damages the heart, blood vessels and pericardium. Radiotherapy combined with chemotherapy at the end of the injury as acute injury, mainly involving the myocardium and pericardium, the performance of ST-T changes, mainly six months after the sinoatrial node lesions; most of the acute injury and most of the repairable and chronic injury is not easy to repair, requiring radiotherapy As far as possible shrink and avoid the right atrium, while regular review of ECG, early detection, early treatment.