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目的探讨胸腔内注入博来霉素治疗恶性胸腔积液的疗效与毒副反应。方法经病理或胸水细胞学确诊为恶性胸腔积液的患者共42例,随机分为博来霉素(BLM)组22例,胸腔内注入0.9%生理盐水20ml+BLM30㎎+地塞米松5㎎+2%利多卡因5ml;顺铂(PDD)组20例,胸腔内注入0.9%生理盐水20ml+PDD30㎎+地塞米松5㎎+2%利多卡因5ml。7天后重复注射,最多重复4次。观察疗效、生活质量、毒副反应。结果:BLM组总有效率86%,病变进展率0%;较顺铂组55%、30%差异均有显著性(P<0.05);BLM组Karnofsky≥70分者显著高于顺铂组(P<0.05);而BLM组Karnofsky<50分者显著低于PDD组(P<0.05)。治疗后的毒副反应,血小板轻度降低,两组比较无差异,而白细胞降低和消化道反应,BLM组显著低于PDD组(P<0.05)。结论胸腔内注入BLM治疗恶性胸腔积液疗效显著,毒副反应小,是晚期恶性肿瘤姑息治疗的一种有效方法。
Objective To investigate the efficacy and side effects of intrapleural injection of bleomycin in the treatment of malignant pleural effusion. Methods Forty-two patients with malignant pleural effusion diagnosed by pathology or pleural fluid cytology were randomly divided into BLM group (n = 22) and intrapleural injection of 0.9% normal saline (20 ml + BLM30) + dexamethasone + 2% lidocaine 5ml; cisplatin (PDD) group of 20 cases, intrapleural injection of 0.9% saline 20ml + PDD30㎎ + dexamethasone 5㎎ + 2% lidocaine 5ml. Repeat injection after 7 days, up to 4 times. Observation of efficacy, quality of life, side effects. Results: The total effective rate was 86% in BLM group and the rate of lesion progression was 0%. Compared with cisplatin group, the difference was significant (P <0.05). Compared with Cisplatin group, the Karnofsky≥70 score in BLM group was significantly higher than that in cisplatin group (P < 0.05). However, those with Karnofsky <50 in BLM group were significantly lower than those in PDD group (P <0.05). Toxic side effects after treatment, mild platelet reduction, no difference between the two groups, and leukopenia and digestive tract reaction, BLM group was significantly lower than PDD group (P <0.05). Conclusion Intracavitary injection of BLM has significant curative effect on malignant pleural effusion with small toxic and side reaction, which is an effective method for palliative treatment of advanced malignant tumors.