硬膜外麻醉对术前辅助化疗癌症病人心肌肌钙蛋白Ⅰ的影响

EFFECT OF EPIDURAL ANESTHESIA ON CARDIAC TROPONIN Ⅰ IN PREOPERATIVE ADJUVANT CHEMOTHERAPY PATIENTS WITH CANCER

目的:研究硬膜外麻醉对术前辅助化疗癌症病人心肌肌钙蛋白I(cTnI)的影响。方法:选择盆腔、下腹部癌症病人28例,其中观察组14例接受术前辅助化疗(全部为单次静脉化疗用药),对照组14例未行术前辅助化疗,两组病人均在硬膜外麻醉下手术,分别于麻醉前、手术开始后1h、手术结束时、术后1、3、7d采集外周静脉血4mL并分离血清,以检测血清cTnI水平、肌酸激酶(CK)和肌酸激酶同工酶(CKMB)活性。结果:①观察组病人血清cTnI水平于手术结束时开始明显升高(P<0.05),术后1d达峰值(P<0.01),术后3、7d下降,但与麻醉前相比差异显著(P<0.01);②对照组病人血清cTnI水平于手术结束时轻度升高(P>0.05),术后1d达峰值,与麻醉前相比差异显著(P<0.01),但峰值明显较观察组低(P<0.01);③手术结束至术后1、3d,两组病人的血清CK、CKMB活性均较麻醉前明显增高(P<0.05),但各个时点两组比较均无明显差异(P>0.05)。结论:术前辅助化疗癌症病人在接受硬膜外麻醉和手术治疗时,发生心肌损伤的危险性明显增加,应注意心肌损伤的早期识别并及时采取有效的心肌保护措施。

Objective：In order to explore the effect of epidural anesthesia on cardiac troponin I（cTnI）in cancer patients who have accepted preoperative adjuvant chemotherapy. Methods： Twenty-eight cases of pelvis and lower abdomen cancer patients were choiced, fourteen cases of them accepted preoperative adjuvant chemotherapy before epidural anesthesia （observation group）, and other fourteen cases of them didn＇t accepted preoperative adjuvant chemotherapy before epidural anesthesia （control group）. All patients in two groups were performed operation with epidural anesthesia, and peripheral blood samples（4 mL） at 6 time points were drawn from： preanesthesia, 1 hour post-anesthesia, the end of operation, and the first day, the third day, the seventh day postoperation;respectively. Serum cTnI level, CK and CKMB activities were de- termined in the samples. Results： （1） Serum cTnI level increased significantly when the end of operation in observation group （ P 〈0.05）, the peak values on the first day postoperation（ P 〈0.01）, and decreased on the third day and the seventh day postoperation, but cTnI level differed significantly as compared with before anesthesia（ P 〈0.01）. （2） Serum cTnI level increased when the end of operation in control group（ P 〉0.05）, the peak values on the first day postoperation（ P 〈0.01）, but lower significantly compared with observation group. （3）Serum CK and CKMB activities increased from the end of operation to the third day, the seventh day postoperation in two groups（ P 〈0. 05）,but no statistical difference between the two groups（ P 〉0.05）. Conclusion：Preoperative adjuvant chemotherapy could enhance myocardial injury fatal-ness in patients with cancer during epidural anesthesia and operation. Monitoring of serum cTnI level is helpful to detect the early, minor myocardial injury and to take the effective prevention and safeguard in the cancer patients.