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目的探讨卡维地洛联合曲美他嗪对接受含蒽环类药物化疗乳腺癌患者的心脏保护作用。方法选取2011-03-07至2013-06-30山东大学附属临沂市人民医院乳腺与甲状腺科收治的乳腺癌根治术后含蒽环类药物化疗患者114例。采用随机数字表法,将其分为对照组56例和研究组58例。分别于化疗前和化疗3、6个周期后,对两组进行心电图检查、心脏彩超检查、肌钙蛋白T(CTn T)水平检测,并记录化疗过程中的非血液系统不良反应/事件发生情况。结果两组年龄和病理分期分布情况比较,差异无统计学意义(P>0.05)。化疗3个周期后,两组心电图检查ST-T异常发生率比较,差异有统计学意义(P<0.05);而QRS波群电压下降、心律失常发生率比较,差异无统计学意义(P>0.05)。化疗6个周期后,两组ST-T异常、QRS波群电压下降、心律失常发生率比较,差异均有统计学意义(P<0.05)。化疗过程中,两组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室舒张早期快速充盈峰与左心房主动收缩充盈峰比值(E/A)比较,差异有统计学意义(P<0.05);不同时间比较,差异有统计学意义(P<0.05);两者间存在交互作用,差异有统计学意义(P<0.05)。化疗3个周期后,两组CTn T异常发生率比较,差异无统计学意义(P>0.05);化疗6个周期后,两组CTn T异常发生率比较,差异有统计学意义(P<0.05)。化疗期间,患者均发生了脱发现象;两组头晕/头痛、乏力、血压升高、恶心/呕吐、腹胀及腹泻发生率比较,差异无统计学意义(P>0.05);血压下降、心率增快及心率减慢发生率比较,差异有统计学意义(P<0.05)。结论卡维地洛联合曲美他嗪可以降低含蒽环类药物化疗对乳腺癌患者的心脏毒性,且耐受性和安全性较好。
Objective To investigate the cardioprotective effects of carvedilol combined with trimetazidine on breast cancer patients receiving anthracycline chemotherapy. Methods A total of 114 patients with anthracycline-based chemotherapy after radical mastectomy of breast and thyroid in Linyi City People’s Hospital Affiliated to Shandong University from 2011-03-07 to 2013-06-30 were selected. Using a random number table method, it was divided into a control group of 56 cases and a study group of 58 cases. Electrocardiogram, echocardiography, and troponin T (CTn T) levels were measured before chemotherapy and after 3 and 6 cycles of chemotherapy, and non-hematologic adverse events/events during chemotherapy were recorded. . Results There was no significant difference in the distribution of age and pathological stages between the two groups (P>0.05). After 3 cycles of chemotherapy, there was a statistically significant difference in the incidence of ST-T abnormalities between the two groups (P<0.05). However, there was no significant difference in the QRS complex voltage drop and the incidence of arrhythmia (P>0.05). 0.05). After 6 cycles of chemotherapy, ST-T abnormalities, QRS complex voltages, and arrhythmia rates were statistically significant (P<0.05). In the course of chemotherapy, there were statistical differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), early left ventricular diastolic filling peak and left atrial active systolic filling ratio (E/A). Significance (P<0.05); There was a statistically significant difference between different time points (P<0.05); there was an interaction between the two, the difference was statistically significant (P<0.05). After 3 cycles of chemotherapy, the incidence of CTn T abnormalities in the two groups was not statistically different (P>0.05). After 6 cycles of chemotherapy, the incidence of CTn T abnormalities in the two groups was statistically significant (P<0.05). ). During the period of chemotherapy, all patients had ablates; there was no significant difference in dizziness/headache, fatigue, high blood pressure, nausea/vomiting, abdominal distension, and diarrhea between the two groups (P>0.05); blood pressure decreased and heart rate increased. Compared with the incidence of heart rate slowdown, the difference was statistically significant (P<0.05). Conclusion Carvedilol combined with trimetazidine can reduce the cardiotoxicity of anthracycline-containing chemotherapy for breast cancer patients, and has better tolerability and safety.