不同输液途径对胃肠道恶性肿瘤化疗效果的影响

目的探讨PICC置管结合便携式化疗泵与留置针外周静脉滴注两种输液途径在胃肠道恶性肿瘤化疗奥沙利铂（OXA）、亚叶酸钙（CF）联合5-氟尿嘧啶（5-FU）方案中的临床应用效果。方法58例胃肠道恶性肿瘤行OXA、CF联合5．Fu方案化疗患者，A组34例采用经外周静脉中心静脉置管（PmC）结合便携式化疗泵给药。方案为FOLOX6：OXA100mg／m2静脉点滴2h，d1；CF400ms／m2静脉点滴2h，dl；5-FU400mg／m2静推，dl；后以5-FU2．4g／m2，入化疗泵持续静脉输注46h，每2周重复。B组24例采取留置针外周静脉滴注化疗，方案为：OXA130ms／m2静滴，d1；CF100ms／d静脉滴注，d1—5，5．FU450ms／m2静滴，d1～5；3周重复，观察两组疗效和毒副反应。结果A组一次插管成功率为88．2％，留置时间5—180d，平均置管时间为62d；8．8％出现静脉炎，化疗有效率47．0％（16／34）。B组一次插管成功率为84．3％，留置时间1～3d，平均2．5d；20．8％出现静脉炎，化疗有效率37．5％（9／24）。A组化疗副反应发生率明显高于B组，其差异具显著性。结论胃肠道恶性肿瘤患者奥沙利铂（OXA）、亚叶酸钙（CF）联合5-氟尿嘧啶（5-FU）方案，采用经PICC管结合化疗泵化疗治疗，不仅提高化疗效果，降低毒副反应，同时提高患者生活质量，明显优于外周静脉留置针静脉滴注化疗，值得临床推广。

Influence of different transfusion pathway in gastrointestinal cancer chemotherapy

Objective This study wag to compared the efficacy and toxicity in gastrointestinal cancer chemotherapy with oxaliplatin,leucovorin and 5-fluorouracil when it wad given with PICC line(Peripherally Inserted Central Catheter)combined chemotherapy pump or with peripheral vein catheter catheterization.Methods 58 patients with gastrointestinal cancer were treated by oxaliplatin,leucovofin and 5-fluomuracil.34cases in group A were given with PICC line(Peripherally Inserted Central Catheter)combined chemotherapy pump.The regimen was FOLFOX6 which consisted of 2-hour infusion of oxaliplatin(OXA)(100 ms/m2)and 2-hour infusion of leucovorin(CF)(400 mg/m2)on Day 1,and by5-fluorouracil(5-FU)400 mg/m2)on Day 1 and 46-hour infusion(2.4 g/m2)used by chemotherapy pump.and all chemotherapy drug were siven through PICC.the regimen wag repeated at 2-week intervals.24 crises in group B were given with peripheral vein catheter catheterization.The regimen consisted of infusion of OXA(130 mg/m2)Day 1 and infusion of CF(100 mg/m2)and 5-FU(450 mg/m2)on Day 1～5,the regimen wag repeated at 3-week intervals.The clinical efficacy and adverse events were evaluated.Results The achievement ratio of catheterization in group A wag 93.1%,the detain time wag 5～180 days,average detain time was 62 days,phlebitis developed in 8.8%(3/34),overall gesponse rate(OR)was 47.0%(16/34).The achievement ratio of catheterization in group B wag 88.2%,the detain time was 1-3 days.average detain time wag 2.5 days,phlebitis developed in 20.8%(5/24),overall response rate(OR)wag 37.5%(9/24).The rate of peripheral neuritis,gastrointestinal reaction,and myelosuppression in group A were higher than group B,there were significant different between two group.Conclusions Compared with peripheral vein catheter catheterization,it is more efficacy and less toxieity with oxaliplatin,leucovorin and 5-fluorouracil regimen in treating gastrointestinal cancer with PICC line,and improved quality of life of these patients.It can be popularized.