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超声心动图联合心电图评估非小细胞肺癌放化疗后患者心脏损伤的应用研究

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摘要:

目的 研究超声心动图联合心电图对非小细胞肺癌放化疗后患者心脏损伤的评估应用,为
临床治疗提供有效依据。方法 选择2016年1月至2017年6月于解放军总医院第一附属医院收治的145例
非小细胞肺癌放化疗患者作为研究对象,在对患者进行放化疗后采用超声心动图联合心电图对患者进
行检查分析,对心脏的心电图和超声心动图结果进行分析,比较治疗后的患者两种检验方法的心脏损
伤的检出情况。结果 患者在接受放化疗治疗2周后,患者心电图指标HR、QTc(83.15±14.19 次/min、
439.75±21.55 ms)明显高于放化疗治疗前(74.38±11.05 次/min、414.47±19.54 ms,P<0.05),而
QRS波幅、T波幅(2.18±0.44 mV、0.32±0.10 mV)明显低于治疗前(1.86±0.21 mV、0.24±0.03 mV,
P<0.05)。患者超声心动图指标左室射血分数(LVEF)、左心室短轴缩短率(FS)、脉冲式多普勒超
声检测指标包括左房室瓣舒张早期最大峰值速度(E峰)、舒张晚期最大峰值速度(A峰)、E/A比值
(61.08±4.19%、34.25±4.01%、66.98±14.28%、0.91±0.16)明显低于放化疗治疗前(67.98±4.89%、
37.83±4.32%、74.67±21.06%、1.24±0.30,P<0.05)。采用超声心动图和心电图对患者的心脏损伤
进行检测,发现超声心动图与心电图检查对于心肌炎、心律失常、冠脉事件的检出率比较无明显差异
(58.82%、57.14%、63.41%;58.82%、33.33%、75.61%,P>0.05);超声心动图对于瓣膜疾病的检出
率(83.87%)明显高于心电图检查(66.13%,P<0.05),而心电图检查对于传导系统损伤及心肌缺血
或损伤的检出率(93.24%、93.55%)明显高于超声心动图检查(71.62%、69.35%,P<0.05),联合检
查对于放射性心脏损伤疾病(本研究中指心肌炎、心律失常、冠脉事件、瓣膜疾病、传导系统损伤及心
肌缺血或损伤)的检出率(88.23%、83.33%、97.56%、96.77%、97.29%、98.38%)明显高于单独采用
超声心动图或心电图检查(P均<0.05)。结论 在进行放化疗之后,患者的心功能发生了显著的变化,
相对于单独使用超声心动图或心电图进行检测,超声心动图联合心电图对非小细胞肺癌放化疗后患者心
脏损伤的检测能够显著的提高对患者心脏损伤疾病的检出率,能够较准确地检测出单个检测方法无特异
度的疾病,有利于对患者进行及时治疗,减少患者治疗后的痛苦,提早干预,改善患者预后,值得在临
床上推广使用。

Abstract:

Objective To study the application of echocardiogram combined with electrocardiogram (ECG)
in reviewing cardiac injury in patients with non-small cell lung cancer (NSCLC) after chemoradiotherapy, and
provide effective evidence for clinical treatment. Methods NSCLC patients (n=145) were chosen from the First
Affiliated Hospital of Chinese PLA General Hospital from Jan. 2016 to June 2017. After chemoradiotherapy, all
patients were given examinations of echocardiogram combined with ECG. The results of ECG and echocardiogram
were analyzed, and detection of cardiac injury were compared between echocardiogram and ECG. Results After
treatment for 2 weeks, HR and QTc in ECG (83.15±14.19 time/min, 439.75±21.55 ms) were significantly higher
than those before treatment (74.38±11.05 time/min, 414.47±19.54 ms, P<0.05), and QRS wave amplitude and
T wave amplitude in ECG (2.18±0.44 mV, 0.32±0.10 mV) were significantly lower than those before treatment
(1.86±0.21 mV, 0.24±0.03 mV, P<0.05). The indexes of echocardiogram in including left ventricular ejection
fraction (LVEF) and left ventricular fraction shortening (LVFS), indexes of pulsed Doppler ultrasound detection

including left atrioventricular valve early-diastolic maximum peak velocity (peak E), late-diastolic maximum peak

velocity (peak A) and E/A ratio were significantly lower (61.08±4.19%, 34.25±4.01%, 66.98±14.28%, 0.91±
0.16) after treatment than those before treatment (67.98±4.89%, 37.83±4.32%, 74.67±21.06%, 1.24±0.30,
P<0.05). There were no significant differences in the detection rates of myocarditis, arrhythmia and coronary events
between echocardiogram and ECG (58.82%, 57.14%, 63.41%; 58.82%, 33.33%, 75.61%, P>0.05). The detection
rate of valvular disease by echocardiogram (83.87%) was significantly higher than that by ECG (66.13%, P<0.05),
and detection rates of conduction system injury and myocardial ischemia or injury by ECG (93.24%, 93.55%) were
significantly higher than those by echocardiogram (71.62%, 69.35%, P<0.05). The detection rates of radioactive
heart disease (myocarditis, arrhythmia, coronary events, valvular disease, conduction system damage and myocardial
ischemia or injury) by echocardiogram combined with ECG (88.23%, 83.33%, 97.56%, 96.77%, 97.29%, 98.38%)
were significantly higher than those by echocardiogram alone or ECD alone (all P<0.05). Conclusion After
chemoradiotherapy, patient’s heart function will have significant changes. Compared with echocardiogram alone
or ECD alone, echocardiogram combined with ECG can significantly increase the detection rates of cardiac injury
diseases in NSCLC patients. The disease with no specificity of single detection method can be accurately detected.
It is beneficial to timely given patients treatment, reduce post-treatment pain, and perform early intervention to
improve prognosis, which is well worth clinical application.

基金项目:

解放军总医院科技创新苗圃基金(14KMM26)

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