目的 探讨碳酸氢钠联合载药微球表柔比星治疗原发性肝癌的短期疗效和安全性。方法 选取2014年8月—2017年8月在焦作市中医院诊治的84例原发性肝癌患者作为研究对象，根据随机数字表法分为对照组和观察组，每组各42例。对照组患者给予载药微球介入治疗，将盐酸表柔比星注射液，50 mg溶于20 mL生理盐水中，将10 mL表柔比星溶液注入100～300 μm的Collisphere微球瓶中，混匀后静置10 min，用剩余的10 mL表柔比星注射器抽取微球瓶内悬液，混入非离子型等渗对比剂20 mL，均匀后抽取微球悬液进行常规介入栓塞治疗，6周为一个疗程，共治疗2个疗程。观察组患者在对照组治疗的基础上给予碳酸氢钠辅助治疗，在介入前1 d与介入后7 d分别经靶动脉灌注50 mL 5%碳酸氢钠注射液和生理盐水30 mL各1次。两组均治疗3个月。记录两组患者的短期疗效、毒副反应发生情况和两组治疗前后的肝功能指标水平。结果 治疗后，观察组的客观缓解率为76.2%，显著高于对照组的47.6%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者血清天冬氨酸氨基转移酶（AST）与丙氨酸氨基转移酶（ALT）水平显著低于治疗前，同组治疗前后比较差异具有统计学意义（P<0.05）；观察组AST与ALT水平显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗期间，两组患者的毒副反应发生情况组间对比差异无统计学意义。结论 碳酸氢钠联合载药微球表柔比星治疗原发性肝癌能提高治疗效果，且不会增加毒副反应的发生，也能改善患者的肝功能，具有一定的临床推广应用价值。

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