CAJ | 학술논문

目的比较不同麻醉对表柔吡星化疗后乳腺癌根治术患者QT问期的影响.方法拟行乳腺癌根治术患者80例,乳腺癌ⅡA或ⅢA期,年龄28-64岁,ASA Ⅰ或Ⅱ级.术前进行环磷酰胺-5-氟尿嘧啶-表柔吡星新辅助化疗2～4周期的患者加例,随机分为Al组和AP组,每组20例;术前未化疗的患者加例,随机分为CI组和CP组,每组20例.AI组和CI组吸入1.0%.1.5%异氟醚,AP组和CP组静脉靶控输注异丙酚(血浆靶浓度1.8～2.0 mg/L)维持麻醉.于化疗前(T1)、化疗后2周(T2)、气管插管前(T3)、气管插管后即刻(T4)、吸入异氟醚或靶控输注异丙酚5、10、15、30 min(T5-8)和拔除气管导管后10min(T9)时记录QT间期和QT期延长的发生情况;于T1-7时计算QT离散度.结果与T1时比较,T2-7时A1组和AP组OT离散度增加(P<0.05);与T2时比较,AI组T6-8时QT间期较长(P<0.05);与CI组比较,T6-8时AI组OT间期较长,T5-7时QT离散度增加(P<0.05);AI组QT间期延长发生率较CI组、AP组和cP组高(P<0.05);CP组与AP组、AI组与AP组各时点QT间期和QT离散度差异无统计学意义(P>0.05).结论与异氟醚复合瑞芬太尼麻醉相比,异丙酚复合瑞芬太尼麻醉对表柔吡星化疗后乳腺癌根治术患者QT间期影响较小,QT间期延长发生的机率及QT离散度降低.
목적 비교불동마취대표유필성화료후유선암근치술환자QT문기적영향.방법 의행유선암근치술환자80례,유선암ⅡA혹ⅢA기,년령28-64세,ASA Ⅰ혹Ⅱ급.술전진행배린선알-5-불뇨밀정-표유필성신보조화료2～4주기적환자가례,수궤분위Al조화AP조,매조20례;술전미화료적환자가례,수궤분위CI조화CP조,매조20례.AI조화CI조흡입1.0%.1.5%이불미,AP조화CP조정맥파공수주이병분(혈장파농도1.8～2.0 mg/L)유지마취.우화료전(T1)、화료후2주(T2)、기관삽관전(T3)、기관삽관후즉각(T4)、흡입이불미혹파공수주이병분5、10、15、30 min(T5-8)화발제기관도관후10min(T9)시기록QT간기화QT기연장적발생정황;우T1-7시계산QT리산도.결과 여T1시비교,T2-7시A1조화AP조OT리산도증가(P<0.05);여T2시비교,AI조T6-8시QT간기교장(P<0.05);여CI조비교,T6-8시AI조OT간기교장,T5-7시QT리산도증가(P<0.05);AI조QT간기연장발생솔교CI조、AP조화cP조고(P<0.05);CP조여AP조、AI조여AP조각시점QT간기화QT리산도차이무통계학의의(P>0.05).결론 여이불미복합서분태니마취상비,이병분복합서분태니마취대표유필성화료후유선암근치술환자QT간기영향교소,QT간기연장발생적궤솔급QT리산도강저.
Objective To compare the effects of dillerent anesthesia methods on QT interval in the patients undergoing radical mastectomy after unthracycline chemotherapy.Methods Eighty ASA Ⅰ orⅡpatients with stage Ⅱ A or Ⅲ A breast cancer.aged 28-64 vr,scheduled for radical nmsteetomy under general anesthesia were enrolled in this study.Forty patients receiving 2-4 cycles of cytocan-5-fluorouracil.anthracycline based neoadjuvant chemotherapy before the operation were randomly divided into 2 groups(n=20 each):group AI and AP;Forty patients not subjected to the chemotherapy were randomly divided into 2 groups(n=20 each):group CI and CP.Anesthesia was maintained with 1.0%-1.5%isoflurane in group AI and CI,and propofol via TCI(target plasma concentration set at 1.8-2.0 mg/L)in group AP and CP.QT interval and QT interval prolongation.were recorded at before chemotherapy(T1),at 2 weeks after chemotherapy(T2),immediately before tracheal inmbation(T3),immediately after tracheal intubation(T4),at 5,10,15 and 30 min of inhalation of isflurane or iv infusion of propofol(T5-8)and at 10 min after tracheal intubafion(T9).QT interval dispersion was calculated at T1-7.Results QT interval dispersion was significantly longer at T2-7 than at T1 in group A1 and AP(P<0.05).QT interval was significantly longer at T6-8 than at T2 in group M.QT interval was ignificantly longer at T6-8 and QT interval dispersion higher at T1-7 in group AI than in group CI(P<0.05).The incidence of qr interval prolongation was significantly higher in group AI than in group CI, AP and CP ( P < 0.05). There were no significant differences in QT interval and QT interval dispersion at each time point between group CP and AP and between group AI and AP ( P > 0.05). Conclusion Propofol combined with remifentanil anesthesia has less effect on QT interval than isoflurane combined with remifentanil anesthesia, and the probability of QT interval prolongation was lower and QT interval dispersion shorter in patients undergoing radical mastectomy after anthracycline chemotherapy.