多柔比星引起心肌毒性的研究进展

多柔比星是一种常用的化疗药物,广泛应用于实体瘤及血液系统恶性肿瘤的治疗.由于其可造成心肌细胞的损伤引起心肌病甚至允血性心力衰竭而限制其在肿瘤化疗中的应用,熟悉其引起心肌毒性机制、危险因素和早期监测指标等有利于早期发现并采取干预手段而使多柔比星引起的心肌毒性降至最低.     

儿童急性白血病治疗相关心脏毒性六例临床分析

目的 了解儿童急性白血病治疗相关心脏毒性的发生、监测及预防.方法 总结4例急性白血病患儿化疗中及化疗后出现的相关心血管系统改变,并对其化疗药物累积剂量、心脏毒性发生时间及相关辅助检查结果进行分析.结果 临床及亚临床心脏毒性与蒽环类药物的累积剂量有关(建议小于300 mg/m~2),对患儿心电图、心脏超声进行动态监测有助于早期发现心功能改变.结论 儿童急性自血病的治疗应采取精确的危险分组,注意药物的累积剂量,监测患儿的心脏功能,避免过度治疗,可提高急性白血病患儿的总体生存率及生存质量.     

蒽环类药物治疗儿童恶性肿瘤所致心脏毒性的评价研究进展

蒽环类药物是一类来源于波赛链霉菌青灰变种的化疗药物,是细胞周期非特异性的细胞毒性药物,作为目前治疗儿童白血病、淋巴瘤及多种实体肿瘤的一线化疗药物,具有广泛的抗肿瘤效应.但蒽环类药物引起的不良反应如心脏毒性、骨髓抑制、脱发等,尤其是心脏毒性,往往呈进展性且具有不可逆性,极大地影响了患儿的远期生活质量.对蒽环类药物心脏毒性早期发现、诊断及相应干预是目前临床心脏损害的研究热点.临床上用于监测蒽环类药物心脏毒性的方法很多,如何有效监测葸环类药物所致心脏毒性显得尤为重要.该文针对蒽环类药物所致心脏毒性评价方面的研究进展作一综述.     

儿童常用抗肿瘤药物的心脏毒性

在儿童肿瘤治疗过程中,许多临床常用的抗肿瘤药物都有不同程度的心脏毒性,常见的心脏毒性包括心脏节律改变、血压变化、缺血、心脏收缩或舒张功能异常等。在化疗的过程中需要对心脏功能进行监测,并采取有效的措施保护心肌,以有效降低毒性,减少心血管并发症的发生。     

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化疗是治疗儿童恶性肿瘤的主要手段之一,大多数患儿在治疗的不同时期需要不同强度的化疗。目前临床所应用的化疗药物均缺乏特异性,即在杀伤肿瘤细胞的同时亦会不同程度地损害机体的正常组织细胞,产生许多不良反应,如肾毒性、心脏毒性、骨髓毒性等。正确认识化疗药物的不良反应,采用适当方法减少化疗的毒副作用,对于降低肿瘤患儿的死亡率并改善其生活质量具有十分重要意义。1化疗药物不良反应的分类化疗药物不良反应的分类方法很多,根据药物对机体不同系统、器官的损害,可作如下分类(见表1)。表1化疗药物引起机体不同系统不良反应的主要表现…     

蒽环类抗肿瘤药物的心脏毒性

蒽环类抗肿瘤药物是广谱抗肿瘤的抗生素,对多种实体肿瘤和血液系统肿瘤具有良好的治疗效果,因其结构中含有蒽醌基团故而得名.1973年Lefrak首次报道了该类药物的心脏毒性作用,并且认为心脏毒性比其他副作用更危险.因此,蒽环类抗肿瘤药物的心脏毒性限制了其在肿瘤治疗中的应用.本文将对蒽环类抗肿瘤药物心脏毒性的产生机制、临床表现、监测方法及针对该药物的心脏保护方法作一综述.     

化疗静脉给药防止渗漏的方法和保护

目前，化疗对恶性肿瘤来说，是一种重要的治疗手段，静脉是给药的主要途径。化疗药物毒性一般都很强。在化疗时，要密切观察患儿用药局部皮肤反应，化疗药物外渗，如处理不当，将导致局部皮肤受损，不但给患儿及家长带来痛苦，也给治疗和护理工作造成很多不便，因此，护士对患儿行化疗时，从各个方面如何防止药物外渗是很值得大家探讨的一个问题。     

肝母细胞瘤患儿应用吡柔比星治疗前后实验室指标变化

目的 探讨肝母细胞瘤(hepatoblastoma,HB)患儿应用吡柔比星(pirarubicin,THP)化疗前后心脏毒性的实验室指标变化特点.方法 收集2012年1月至2015年6月我院收治的76例HB术后并给予含THP方案化疗后患儿的临床资料,应用统计学方法分析THP治疗前后血清实验室指标N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)及肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)的变化特点.结果 76例患儿均未发生明确的心脏毒性.THP化疗前后血清NT-proBNP的水平分别为(80.93±74.13)ng/L和(211.85±211.42)ng/L,差异有统计学意义(P=0.00,P<0.05).THP累积剂量>200mg/m2治疗组化疗后血清NT-proBNP水平为(225.67±237.63)ng/L,高于THP累积剂量≤200mg/m2治疗组化疗后血清NT-proBNP水平(182.39±140.43)ng/L,但两组差异无统计学意义(P=0.338,P>0.05).THP化疗前后血清CKMB水平分别为(23.08±13.52)U/L和(30.90±13.92)U/L,变化有统计学差异(P=0.00,P<0.05).结论 儿童HB术后在应用THP化疗后血清NT-proBNP显著升高,对于早期监测心脏毒性有一定的临床意义.     

柔红霉素对白血病儿童心脏毒性的研究进展

白血病是小儿时期最常见的恶性肿瘤 ,柔红霉素是小儿白血病联合化疗中的基本药物。由于柔红霉素易诱发不可逆性心脏毒性 ,因而限制了它的临床应用。 30多年来国内外学者对此进行了大量的临床观察和实验研究 ,对心脏毒性进行分类 ,对相关危险因素进行了研究 ,从细胞水平和分子水平阐述其发病机制 ,提出有效的防治措施 ,从各个环节减少心脏毒性发生 ,提高生存质量 ,延长患儿生命。     

小儿白血病化疗药物的毒性反应及处理

小儿白血病主要的治疗方法是化疗,由于化疗方法的改进,使小儿急性白血病的治疗效果明显提高,尤其是小儿急性淋巴细胞性白血病。同时不可忽视的是,随着化疗药物的不断增多,与化疗药物相关的并发症也不断涌现,除由骨髓抑制所致的最常见的感染并发症外,还有一些其他常见且严重的化疗药物所致的毒性反应,特别是心脏损害,主要见于蒽环类药物;肝脏毒性,主要由甲氨蝶呤引起;肾脏毒性主要由环磷酰胺所致,这些毒性反应如未予充分重视,亦可导致小儿白血病治疗的失败。     

Pubertal growth and development and prenatal and lactational exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene

OBJECTIVES: Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) are ubiquitous toxic environmental contaminants. Prenatal and early life exposures affect pubertal events in experimental animals. We studied whether prenatal or lactational exposures to background levels of PCBs or DDE were associated with altered pubertal growth and development in humans.Study design: Follow-up of 594 children from an existing North Carolina cohort whose prenatal and lactational exposures had previously been measured. Height, weight, and stage of pubertal development were assessed through annual mail questionnaires. RESULTS: Height of boys at puberty increased with transplacental exposure to DDE, as did weight adjusted for height; adjusted means for those with the highest exposures (maternal concentration 4+ ppm fat) were 6.3 cm taller and 6.9 kg larger than those with the lowest (0 to 1 ppm). There was no effect on the ages at which pubertal stages were attained. Lactational exposures to DDE had no apparent effects; neither did transplacental or lactational exposure to PCBs. Girls with the highest transplacental PCB exposures were heavier for their heights than other girls by 5.4 kg, but differences were significant only if the analysis was restricted to white girls. CONCLUSIONS: Prenatal exposures at background levels may affect body size at puberty.     

Hypokalemia and Hyperkalemia in Infants and Children: Pathophysiology and Treatment

Potassium is the second most abundant cation in the body. About 98% of potassium is intracellular and that is particularly in the skeletal muscle. Electrical disturbances associated with disorders of potassium homeostasis are a function of both the extracellular and intracellular potassium concentrations. Clinical disorders of potassium homeostasis occur with some regularity, especially in hospitalized patients receiving many medications. This article will review the pathophysiology of potassium homeostasis, symptoms, causes, and treatment of hypo- and hyperkalemia.     

Prevention and treatment of overweight and obesity in children and adolescents

Increasing numbers of obese children and adolescents all over the world demand an investment in the primary and secondary prevention of obesity and overweight in this age group. The goal of preventive measures in children is to avoid the negative short- and long-term health problems associated with obesity. Primary prevention aims at establishing a healthy, active lifestyle and keeping children and adolescents within a range of body weight which is considered to be healthy. Constant availability and affordability of palatable and energy-dense food in the affluent society of the western world demands preventive strategies. Universal or public health prevention seems to be the most suitable form because several other cofactors of morbidity and mortality of affluent societies can also be prevented. However, in most European countries there is a lack of awareness of the necessity of prevention programmes, not only among the general population but also among the medical society. More awareness and consciousness to the problem of obesity must be generated in order to lead to effective therapeutic programmes. For those children and adolescents who are already obese, secondary prevention is mandatory. Therapeutic intervention programmes for the obese aim at long-term weight maintenance and normalisation of body weight and body fat. They have to modify eating and exercise behaviour of the obese child and establish new, healthier behaviour and lifestyle. Treatments programmes must include behavioural components in order to permanently change nutrition and physical exercise of the obese children and adolescents. However, long-term results of treatment programmes in European countries are scarce and the reported results, even of multidisciplinary regimens, are not impressive. Conclusion In most European countries there is an urgent need not only for a growing awareness of the problem of obesity in children and adolescents but also for development of new comprehensive approaches in treating this group.