目的:評價國產吉西他濱(澤菲)聯合順鉑二線治療晚期乳腺癌的療效和不良反應。方法:34例晚期乳腺癌患者采用國產吉西他濱1000mg/m2,靜脈滴注30min,第1、8天;順鉑25mg/m2,靜脈滴注,第1～3天。21d為一個周期,至少完成兩周期后評價療效。結果:完全緩解2例(588%),部分緩解16例(4706%),總有效率為5294%。中位疾病進展時間為65月,中位生存期為114月;主要不良反應為骨髓抑制和胃腸道反應,所有不良反應在停藥后或對癥處理后均可恢復正常。結論:國產吉西他濱聯合順鉑二線治療晚期乳腺癌療效較好,毒副反應可耐受,值得進一步研究。
Objective To investigate clinical features and risk factors of prolonged postoperative recovery of pediatric patients in ICU after total cavopulmonary connection（TCPC），provide evidence for risk stratification management strategy， and enhance their postoperative recovery. Methods We conducted a retrospective analysis of clinical data of 81 patients undergoing TCPC in Fu Wai Hospital from January 2010 to July 2012. Three patients who died postoperatively were excluded from analysis. Prolonged postoperative recovery was defined as patients whose postoperative mechanical ventilation time was longer than that of 75% of all the patients. A total of 78 patients were divided into normal recovery group and prolonged recovery group. There were 59 patients in the normal recovery group including 34 male and 25 female patients with their age of 62.5±20.7 months，and 19 patients in the prolonged recovery group including 11 male and 8 female patients with their age of 64.8±29.8 months. Perioperative variables were compared between the two groups. Results The average cardiopulmonary bypass time of all the 81 patients was 107.6±54.1 （33-350） minutes. The average aortic cross-clamping time of 17 patients was 46.4±31.5 （22-143） minutes. Three patients （3.7%） died postoperatively because of severe low cardiac output syndrome and thrombosis in the extracardiac conduit. The mechanical ventilation time and ICU stay were 7.5 hours and 1.6 days respectively in the normal recovery group，which were both significantly prolonged in the prolonged recovery group. Preoperative high hemoglobin level，coexistence of intracardiac anomalies，longer cardiopulmonary bypass time，and non-fenestrated procedure were the main risk factors of prolonged postoperative recovery. Conclusion Early extubation and fast track recovery can be achieved in most of TCPC patients. Risk stratification management strategies may contribute to successful postoperative recovery of critical patients after TCPC.