顺铂联合华蟾素注射液心包灌注治疗恶性心包积液

摘要

Objective To evaluate the efficacy of cisplatin in combination with bufonin injection on malignant pericardial effusion. Methods 44 patients with malignant pericardial effusion were divided into cisplatin plus bufonin injection (CPB)group (n=21) and cisplatin (CP) alone group (n=23). Ultrasound-guided percutaneous pericardiocentesis was conducted via Seldinger method and arrow central venous catheter was placed to drain pericardial effusion. Subsequently,pericardial cavity perfusion was conducted in patients in the CPB group with cisplatin 40mg,bufonin injection 20ml and dexamethasone 5mg,and in patients in cisplatin group with cisplatin 40mg and dexamethasone 5mg. The therapeutic effects were evaluated by the effusion in Serous Cavities Evaluation Criteria of WHO and by the RECIST v1.1. The adverse effects were evaluated by the NCI CTC 3.0. Results Catheters were successfully placed into the pericardial spaces to drain effusion in all patients without severe complications. The overall response rates of the cisplatin plus bufonin injection group and cisplatin group were 85.7％ and 56.5％ respectively. The adverse effects were I～II degree of nausea,vomiting,bone marrow suppression and chest pain. Conclusion Ultrasound-guided puncture pericardiocentesis and catheter drainage follow by injection of cisplatin,bufonin and dexamethasone is safe and effective for pericardial effusion and tamponade.%目的 观察顺铂联合华蟾素注射液心包灌注治疗肿瘤晚期恶性心包积液的临床疗效.方法 恶性心包积液患者44例按治疗方案分为顺铂联合华蟾素组(联合组)21例和顺铂组(化疗组)23例,均采用Seldinger技术,B超导引下经皮心包穿刺,置入Arrow中心静脉导管,充分引流心包积液.联合组向腔内注入顺铂40mg、华蟾素注射液20ml、地塞米松5mg;化疗组向腔内注入顺铂40mg、地塞米松5mg,夹管保留药物.采用WHO制定的浆膜腔积液疗效评价标准和RECIST 1.1版非靶病灶评价标准评价客观疗效,采用美国癌症研究所常见毒性判定标准NCI CTC3.0评价不良反应.结果 所有患者均穿刺置管引流成功,心包填塞症状消失.联合组和化疗组总有效率分别85.7％和56.5％.不良反应主要为Ⅰ～Ⅱ度的恶心、呕吐等消化道反应、骨髓抑制和胸痛.结论 心包穿刺置管引流后腔内灌注顺铂和华蟾素注射液是治疗恶性心包积液安全有效的方法.