Battin J, Richir C, Bui N B, Hehunstre J P, Abecassis S
Ann Pediatr (Paris). 1989 Feb;36(2):136-40.
We report a case that illustrates the risk of major, irreversible heart failure despite theoretically safe cumulative doses of adriamycin. We discuss risk factors for cardiotoxicity, predictive methods among which echocardiography is the most useful, and preventive measures. Data are still lacking concerning long term consequences on cardiac function. Until less cardiotoxic adriamycin derivatives become available, modifications in the treatment regimen can be proposed, including a tolerance test, lower doses approximating 20 mg per week instead of 60 mg every three weeks, and administration by continuous infusion through a deep catheter or a pump as cardiotoxicity seems more dependent on drug level peaks than on total dose. These measures should reduce the hazards of adriamycin, a drug that also has potent antimitotic properties.
我们报告了一例病例，该病例表明，尽管阿霉素的累积剂量在理论上是安全的，但仍存在严重、不可逆心力衰竭的风险。我们讨论了心脏毒性的危险因素、预测方法（其中超声心动图最为有用）以及预防措施。关于心脏功能的长期后果，目前仍缺乏相关数据。在毒性较小的阿霉素衍生物问世之前，可以对治疗方案进行调整，包括进行耐受性试验、将剂量降低至每周约20毫克而非每三周60毫克，以及通过深静脉导管或泵持续输注给药，因为心脏毒性似乎更取决于药物浓度峰值而非总剂量。这些措施应能降低阿霉素的危害，而阿霉素同时还具有强大的抗有丝分裂特性。
