目的 探討碳酸氫鈉聯(lián)合載藥微球表柔比星治療原發(fā)性肝癌的短期療效和安全性。方法 選取2014年8月—2017年8月在焦作市中醫(yī)院診治的84例原發(fā)性肝癌患者作為研究對象，根據(jù)隨機數(shù)字表法分為對照組和觀察組，每組各42例。對照組患者給予載藥微球介入治療，將鹽酸表柔比星注射液，50 mg溶于20 mL生理鹽水中，將10 mL表柔比星溶液注入100～300 μm的Collisphere微球瓶中，混勻后靜置10 min，用剩余的10 mL表柔比星注射器抽取微球瓶內懸液，混入非離子型等滲對比劑20 mL，均勻后抽取微球懸液進行常規(guī)介入栓塞治療，6周為一個療程，共治療2個療程。觀察組患者在對照組治療的基礎上給予碳酸氫鈉輔助治療，在介入前1 d與介入后7 d分別經(jīng)靶動脈灌注50 mL 5%碳酸氫鈉注射液和生理鹽水30 mL各1次。兩組均治療3個月。記錄兩組患者的短期療效、毒副反應發(fā)生情況和兩組治療前后的肝功能指標水平。結果 治療后，觀察組的客觀緩解率為76.2%，顯著高于對照組的47.6%，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療后，兩組患者血清天冬氨酸氨基轉移酶（AST）與丙氨酸氨基轉移酶（ALT）水平顯著低于治療前，同組治療前后比較差異具有統(tǒng)計學意義（P<0.05）；觀察組AST與ALT水平顯著低于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療期間，兩組患者的毒副反應發(fā)生情況組間對比差異無統(tǒng)計學意義。結論 碳酸氫鈉聯(lián)合載藥微球表柔比星治療原發(fā)性肝癌能提高治療效果，且不會增加毒副反應的發(fā)生，也能改善患者的肝功能，具有一定的臨床推廣應用價值。

Objective To investigate the short-term efficacy and safety of sodium bicarbonate combined with drug-loaded microspheres epirubicin in treatment of primary hepatocellular carcinoma. Methods Patients (84 cases) with primary hepatocellular carcinoma in the Jiaozuo Traditional Chinese Medicine Hospital from August 2014 to August 2017 were divided into control group and observation group, and each group had 42 cases. Patients in the control group were given the treatment of drug-loaded microspheres intervention, Epirubicin Hydrochloride Injection 50 mg was dissolved in 20 mL saline, and injected 10 mL of epirubicin solution into 100-300 μm Collisphere microsphere bottle, mixed and stand for 10 min, using the remaining 10 mL epirubicin syringe to extract the suspension in the microsphere bottle, mix 20 mL of non-ionic isotonic contrast agent, and then extract the microsphere suspension for routine interventional embolization treatment. 6 weeks is a course of treatment, a total of 2 courses. Patients in the observation group were treated with sodium bicarbonate on the basis of the control group, 50 mL 5% Sodium Bicarbonate Injection and 30 mL normal saline were infused through the target artery on one day before and seven days after the intervention, respectively. Both groups were treated for 3 months. The short-term efficacy, toxic and side effects, and the liver function indexes in two groups before and after treatment were recorded. Results After treatment, the objective remission rate of the observation group was 76.2%, which was significantly higher than 47.6% of the control group, the difference between two groups was statistically significant (P<0.05). After treatment, serum AST and ALT levels in two groups were significantly lower than those before treatment, and the difference before and after treatment in the same group was statistically significant (P<0.05). And the levels of AST and ALT in the observation group were significantly lower than those in the control group, and the difference between the two groups was statistically significant (P<0.05). During the treatment, there was no significant difference between the two groups in the occurrence of toxic and side effects. Conclusion Sodium bicarbonate combined with drug-loaded microspheres epirubicin can improve the therapeutic effect of primary hepatocellular carcinoma without increasing the incidence of toxic and side effects, and can improve the liver function of patients, which has certain clinical promotion and application value.

R979.1