新辅助化疗对乳腺癌根治术后恶心呕吐发生的影响

Influence of neoadjuvant chemotherapy on occurrence of postoperative nausea and vomiting after radical mastectomy

目的探讨新辅助化疗对乳腺癌根治术后恶心呕吐（PONV）发生的影响。方法选择本院拟行乳腺癌改良根治术的患者286例，年龄18～60岁，ASA分级Ⅰ或Ⅱ级，将患者分为未化疗组（n=106）和新辅助化疗组（n=180）。全麻诱导：静脉注射异丙酚2mg／kg、罗库溴铵0．6mg／kg和舒芬太尼0．2μg／kg后，进行气管插管。依据BIS值调节吸人七氟醚浓度，维持BIS值40～50。术毕前30min静脉注射昂丹司琼8mg和氟比洛芬酯100mg。拔除气管插管后至手术后24h期间，如发生连续2次呕吐、持续恶心呕吐且患者要求治疗时给予补救用药。记录术后24h内PONV的发生情况和程度、止吐补救用药情况。结果与未化疗组比较，新辅助化疗组术后24h内PONV发生率和程度增加，止吐补救用药率升高（P〈0．05）。结论术前新辅助化疗可增加乳腺癌改良根治术PONV的发生风险和严重程度。

Objective To investigate the influence of neoadjuvant chemotherapy on the occurrence of postoperative nausea and vomiting （PONV） after radical mastectomy. Methods A total of 286 breast cancer patients, aged 18-60 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective modified radical mastectomy under general anesthesia in our hospital, were divided into either non-chemotherapy group （ n = 106） or neoadjuvent chemotherapy group （ n = 180）. General anesthesia was induced with iv propofol 2 mg/kg, rocuronium 0.6 mg/kg and sufentanil 0.2 μg/kg. The patients were endotracheally intubated. The concentration of sevoflurane inhaled was adjusted according to the value of bispectral index, and bispectral index value was maintain at 40-50. Ondansetron 8 mg and flurhiprofen axetil 100 mg were injected intravenously at 30 rain before the end of surgery. If vomiting occurred for 2 consecutive times, and continuous nausea and vomiting appeared from the time point after extubation to 24 h after surgery, and the patients required treatment, rescue medication was used. The occurrence and severity of PONVwithin 24 h after surgery and requirement for rescue medication were recorded. Results Compared with non-chemotherapy group, the incidence of PONV within 24 h after surgery and requirement for rescue medication were significantly increased, and the severity of PONV was aggravated in neoadjuvent chemotherapy group （P〈0.05）. Conclusion Neoadjuvant chemotherapy before surgery can increase the risk and severity of PONV after modified radical mastectomy.