卵巢癌新辅助化疗因素对异丙酚复合羟考酮麻醉诱导时镇静效力的影响

Effect of neoadjuvant chemotherapy for ovarian cancer on sedative potency of propofol and oxycodone for anesthesia induction

目的评价卵巢癌新辅助化疗因素对异丙酚复合羟考酮麻醉诱导时镇静效力的影响。方法选择择期全麻下行卵巢癌根治术患者68例,ASA分级Ⅰ或Ⅱ级,年龄40~64岁,BMI 20~30 kg/m2。根据术前是否接受新辅助化疗分为2组(n=34):新辅助化疗组(Ⅰ组)和未化疗组(Ⅱ组)。Ⅰ组于术前化疗3个周期(1个化疗周期21 d),化疗方案为紫杉醇复合卡铂,化疗后3周进行手术治疗。麻醉诱导:静脉注射羟考酮0.2 mg/kg,4 min后采用内嵌Marsh药代动力学参数的TCI异丙酚,按序贯法确定异丙酚效应室靶浓度,异丙酚初始效应室靶浓度为1.0 μg/ml,相邻靶浓度之比为1.09。采用Probit法计算异丙酚使患者意识消失的半数有效效应室靶浓度(EC50)及95%可信区间。结果Ⅰ组异丙酚使患者意识消失的EC50及95%可信区间为1.22 μg/ml(1.14-1.30 μg/ml),Ⅱ组为1.74 μg/ml(1.57~3.19 μg/ml)。与Ⅱ组比较,Ⅰ组异丙酚使患者意识消失的EC50降低(P<0.05)。结论卵巢癌新辅助化疗可增强异丙酚复合羟考酮麻醉诱导时的镇静效力。

Objective To evaluate the effect of neoadjuvant chemotherapy for ovarian cancer on the sedative potency of propofol and oxycodone for anesthesia induction. Methods Sixty-eight American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 40-64 yr, with body mass index of 20-30 kg/m2, scheduled for elective radical resection of ovarian cancer with general anesthesia, were divided into into 2 groups(n=34 each)according to whether the patients received neoadjuvant chemotherapy before surgery: neoadjuvant chemotherapy group(groupⅠ)and non-chemotherapy group(group Ⅱ). Patients received 3 cycles of chemotherapy(21 days for 1 cycle), chemotherapy regimen was paclitaxel and carboplatin, and patients underwent surgery after 3 weeks of chemotherapy in group Ⅰ.Anesthesia was induced with Ⅳ oxycodone 0.2 mg/kg.Propofol was given by target-controlled infusion 4 min later, and the effect-site concentration(Ce)of propofol was determined by up-and-down technique, with the initial Ce 1.0 μg/ml and the ratio between the two successive Ces 1.09.The median-effective target plasma concentration(EC50)and 95% confidence interval of propofol causing loss of consciousness were calculated using Probit analysis. Results The EC50 and 95% confidence interval of propofol causing loss of consciousness were 1.22 μg/ml(1.14-1.30 μg/ml)and 1.74 μg/ml(1.57-3.19 μg/ml)in group Ⅰ and group Ⅱ, respectively.Compared with group Ⅱ, the EC50 of propofol causing loss of consciousness was significantly decreased in group Ⅰ(P<0.05). Conclusion Neoadjuvant chemotherapy for ovarian cancer can enhance the sedative potency of propofol and oxycodone for anesthesia induction.