不同麻醉对表柔吡星化疗后乳腺癌根治术患者QT间期的影响

Comparison of Effects of Different Anesthesia Methods on QT Interval in Patients Undergoing Radical Mastectomy after Anthracycline Chemotherapy

目的:分析不同麻醉在乳腺癌根治术患者表柔吡星化疗后QT间期的影响。方法:选择于2017年12月至2018年11月期间在我院接受乳腺癌根治术治疗的患者100例为研究对象,其中有50例患者术前接受环磷酰胺-5-氟尿嘧啶-表柔吡星化疗(CTX+ADM+5-FU, CAF),随机划分为A1组(25例)、A2组(25例),而未接受化疗的50例患者随机划分为B1组(25例)、B2组(25例)。A1组、B1组患者吸入1.0%~1.5%浓度的异氟醚,A2组、B2组患者接受异丙酚静脉靶控输注,分别记录化疗前(T1)、化疗2周后(T2)、气管插管前(T3)、气管插管后(T4)、异氟醚吸入/异丙酚把控输注5min(T5)/10min(T6)/15min(T7)/30min(T8)、气管导管拔除后10min(T9)时的QT间期以及延长情况,并计算T1~T7时QT的离散度。结果:对比T1,T2~T7时A1组患者、A2组患者的QT离散度增加情况存在明显的统计学意义(P<0.05);对比T2时,T6~T8时A1组患者的QT间期相对较长,即差异有统计学意义(P<0.05);T6~T8时,A1组患者的QT间期长于B1组患者,且在T5~T7时,A1组患者的QT离散度增加更为明显(P<0.05);对比四组患者的QT间期延长发生率,A1组数据最为显著,与其他组比较差异有统计学意义(P<0.05);在相同时点,A1组与A2组、B1组与B2组患者的QT间期、QT离散度较为接近,即差异无统计学意义(P>0.05)。结论:相对比异氟醚复合瑞芬太尼,在乳腺癌根治术患者表柔吡星化疗后行异丙酚复合瑞芬太尼,对患者QT间期影响较小,麻醉效果更好。

Objective: To analyze the effect of different anesthesia on QT interval after epiropiramide chemotherapy in patients undergoing radical mastectomy. Methods: From December 2017 to November 2018, 100 patients received radical mastectomy in our hospital. 50 of them received cyclophosphamide 5-fluorouracil and epiropyridine before operation. They were randomly divided into A1 group(25 cases)and A2 group(25 cases), while 50 patients without chemotherapy were randomly divided into B1 group(25 cases), B2 group(25 cases), A1 group, B1 group inhaled 1.0~ 1. % isoflurane, A2 group. The patients in group B2 received target-controlled infusion of propofol before chemotherapy(T1), 2 weeks after chemotherapy(T2), before tracheal intubation(T3), and after endotracheal intubation(T4). Isoflurane inhalation/propofol controlled infusion of 5 min(T5)/10 min(T6)/15 min(T7)/30 min(T8), QT interval and prolongation of 10 min(T9)after extubation, and the dispersion of QT at T1~T7. Results: Compared with A1 group, the increase of QT dispersion in A2 group was statistically significant(P<0.05). Compared with T2, the QT interval in group A1 was longer than that in group A1 at T6~T8(P<0.05). At T6~T8, the QT interval of group A1 was longer than that of group B1, and the dispersion of QT in group A1 was significantly higher than that in group B1 at T5~T7(P<0.05). Compared with the four groups, the incidence of prolonged QT interval in group A1 was the most significant, and the difference was statistically significant compared with other groups(P<0.05). At the same time, the QT interval and QT dispersion of A1 group and A2 group, B1 group and B2 group were similar, that is, the difference was not statistically significant(P>0.05). Conclusion: Compared with isoflurane combined with remifentanil, propofol combined with remifentanil in patients with breast cancer after radical mastectomy has little effect on QT interval and better anesthetic effect.