紫杉醇致卵巢癌患者严重心律失常1例

王秀秀 杨兵

[摘要]紫杉醇是一种具有独特结构和作用机制的抗肿瘤药物，紫杉醇联合铂类为卵巢癌治疗的一线化疗方案。紫杉醇的心脏毒性作用比较少见，但有报道该药可引起无症状的心电图异常、血压改变、心律失常、心肌炎、心包炎、心包填塞、急性心肌梗死、心力衰竭、休克、慢性心肌病等一系列心脏改变，使患者心功能降低，从而影响疗效，降低患者生活质量，这些改变可发生在用药期间或在用药后数年才表现出来。因此，尽早发现紫杉醇的心脏毒性作用，及时采取有效措施，减少心脏并发症的发生，在肿瘤治疗中具有重要意义。本文通过1例卵巢癌患者使用紫杉醇后出现心律失常的案例，对紫杉醇引起心律失常的机制以及处理方案进行了分析和探讨。

[关键词]紫杉醇;心律失常;顺铂;化疗

[中图分类号] R739.63          [文献标识码] A          [文章编号] 1674-4721（2020）7（c）-0189-06

One case of severe arrhythmia caused by Paclitaxel in ovarian cancer patient

WANG Xiu-xiu1   YANG Bing2▲

1. Department of Obstetrics and Gynecology， Fuling Central Hospital of Chongqing City， Chongqing   408000， China; 2. Hospital of Chongqing University of Posts and Telecommunications， Chongqing   400065， China

[Abstract] Paclitaxel is an antitumor drug with unique structure and mechanism of action. Paclitaxel combined with Platinum is the first-choice chemotherapy for ovarian cancer treatment. Cardiotoxicity of Paclitaxel is rare， but there are reports that the drug can cause a series of cardiac changes such as asymptomatic eletrocardiogram abnormalities， blood pressure changes， arrhythmias， myocarditis， pericarditis， tamponade， acute myocardial infarction， heart failure， shock， chronic cardiomyopathy， etc， which reduce heart function of patients， thus affecting curative effect， reducing the quality of life， and these changes may occur during medication or several years after medication. Therefore， it is of great significance in tumor therapy to discover the cardiotoxicity of Paclitaxel as early as possible and take effective measures to reduce the occurrence of cardiac complications. The mechanism and treatment scheme of Paclitaxel-induced arrhythmia were analyzed and discussed through a case of arrhythmia in ovarian cancer patient after Paclitaxel administration.

[Key words] Paclitaxel; Arrhythmia; Cisplatin; Chemotherapy

卵巢癌是常见的女性生殖系统恶性肿瘤，发病率居妇科恶性肿瘤第3位，仅次于宫颈癌和子宫内膜癌，死亡率位列妇科恶性肿瘤之首[1]。卵巢癌发病隐匿，早期患者症状不明显，70%的患者确诊时已分期较晚，其5年生存率约为40%[2]。卵巢癌的标准治疗方法是以手术为主，术后辅以铂类为基础联合紫杉醇的全身化疗。本文报道1例卵巢癌患者使用紫杉醇后出现心律失常的病例，以期引起对于紫杉醇类药物化疗相关不良反应的重视，尽可能降低化疗药物毒副反应，提高肿瘤患者化疗的安全性。

1病例资料

患者，女，42岁，身高155 cm，体重52.5 kg，因“发现盆腔包块3 d”于2019年3月11日入院。……