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目的探讨调强放疗(IMRT)对胸部肿瘤患者不同时间段、不同类型肿瘤、不同治疗方法动态心电图(DCG)的改变。方法接受IMRT的胸部肿瘤患者126例,按照肿瘤类型分为左肺癌组43例,左乳癌组39例,食管癌组44例,按照治疗方法分为单纯放疗组36例,同步放化组46例,序贯放化组44例,分别于治疗前、后,治疗结束半年后进行24 h DCG监测,比较治疗前、治疗结束时、半年后DCG异常发生率及各组治疗前后DCG异常例数。结果偶发房(室)性心律失常、ST-T改变在治疗后较治疗前明显增加,差异有统计学意义(χ2=6.21,P=0.013;χ2=15.14,P=0.000),两者在治疗前与治疗结束半年后比较,差异无统计学意义(P>0.05);治疗前、后不同类型三组肿瘤、不同治疗方法三组患者比较,DCG异常发生例数差异均无统计学意义(P>0.05)。结论胸部肿瘤患者IMRT后DCG改变多出现在治疗早期,为可逆性的;不同类型胸部肿瘤,由于IMRT的精确性,其放疗后DCG改变相似;紫杉类+铂类化疗方案对DCG影响较小,其心脏毒性相对较低。
Objective To investigate the effect of IMRT on dynamic electrocardiogram (DCG) of different types of tumors and different treatment methods in patients with thoracic tumors at different time points. Methods Totally 126 patients with thoracic tumor receiving IMRT were divided into three groups according to their tumor types: left lung cancer group (n = 43), left breast cancer group (n = 39) and esophageal cancer group (n = 44). According to the treatment methods, 36 cases were treated with radiotherapy alone , And 44 patients received sequential radiotherapy. DCG monitoring was performed 24 h after the end of treatment and six months after the end of treatment. The incidence of DCG abnormalities before and after the treatment and the number of DCG abnormalities before and after treatment were compared between the two groups. Results Sporadic atrioventricular arrhythmias, ST-T changes significantly increased after treatment than before treatment, the difference was statistically significant (χ2 = 6.21, P = 0.013; χ2 = 15.14, P = 0.000), both in the treatment Before and after the end of treatment six months later, the difference was not statistically significant (P> 0.05); before and after treatment of different types of three groups of tumors, three groups of patients with different treatment methods, the number of cases of abnormal DCG was no significant difference (P > 0.05). Conclusion DCG changes after IMRT in patients with thoracic tumors are more likely to be reversible in the early stage of treatment. Different types of thoracic tumors have similar changes of DCG after radiotherapy due to the accuracy of IMRT. Taxanes and platinum-based chemotherapy have less effect on DCG , Its cardiotoxicity is relatively low.