新辅助化疗对胃癌手术患者罗库溴铵药效学影响

Effects of neoadjuvant chemotherapy on the pharmacodynamics of rocuronium bromide in patients undergoing gastric cancer surgery

目的:观察新辅助化疗对胃癌手术患者罗库溴铵药效学影响。方法:50例择期行开放胃癌根治术患者,ASA分级Ⅰ或Ⅱ,性别不限,年龄40~68岁,体质量56~79 kg,25例术前未做化疗(N组),25例术前行新辅助化疗(C组)。静脉诱导患者入睡后,给予罗库溴铵 0.9 mg/kg,当4次成串刺激(TOF)为0时插入气管导管,T1恢复至对照值25%时追加罗库溴铵 0.15 mg/kg。记录罗库溴铵起效时间(给药至T1为0时间,t1)、首剂作用时间(首次给药至T1达25%时间,t2)、临床肌松时间(T1从0恢复至25%时间,t3)、恢复指数(T1从25%恢复至75%所需时间,RI)和拔管时间(停用肌松药至T4/T1恢复至90%时间,t4)和罗库溴铵的总用量。结果:与N组相比,C组肌松药首次作用时间延长,临床肌松时间延长,术中总用量减少,恢复指数和拔管时间延长(P<0.05)。两组患者起效时间无统计学差异(P> 0.05)。结论:新辅助化疗可减少术中肌松药的使用量。

AIM: To evaluate the effect of neoadjuvant chemotherapy on neuromuscular block induced by rocuronium in the patients undergoing radical gastrectomy. METHODS:Fifty patients with open gastric cancer, ASA Ⅰ or Ⅱ, aged 40 to 68 years old, 56-79 kg, scheduled for elective radical gastrectomy, were divided into 2 groups (n=25 each) according to whether the patient received neoadjuvant chemotherapy before operation or not: non-chemotherapy group (group N) and neoadjuvent chemotherapy group (group C). Anesthesia was induced with rocuronium 0.9 mg/kg injected intravenous. When T1 recovered to 25% of control height, IV infusion of rocuronium 0.15 mg/kg was used. The onset time, time for T1 to recover to 25%, recovery index and time for train of four ratios to recover to 90%, and the total amount of rocuronium were recorded. RESULTS:Compared with the group N, time for T1 to recover to 25%, recovery index and time for train of four ratios to recover to 90% were significantly prolonged, and the consumption of rocuronium was decreased in group C. There was no significant difference of onset time between the two groups. CONCLUSION:Neoadjuvant chemotherapy can reduce the usage of muscle relaxant in the patients undergoing radical gastrectomy.