新辅助化疗对乳腺癌患者罗库溴铵肌松效应的影响

Effect of neoadjuvant chemotherapy on the rocuronium muscle relaxation in breast cancer patients

目的探讨新辅助化疗对乳腺癌患者罗库溴铵肌松效应的影响。方法选择2018年7月至2019年2月择期全凭静脉麻醉下行乳腺癌根治术的患者60例,年龄29~60岁,BMI 18~29 kg/m^2,ASAⅠ或Ⅱ级,根据术前是否接受新辅助化疗分为化疗组(C组)和非化疗组(NC组),每组30例。C组术前接受阿霉素联合紫杉醇(AT)或阿霉素、环磷酰胺联合紫杉醇(AC-T)方案化疗4周期后行手术治疗;NC组术前未接受新辅助化疗,直接行手术治疗。记录两组患者术前电解质、肝肾功能和入室时、插管即刻、肌松监测值(T1%)恢复至10%、25%、75%时的HR、MAP、SpO 2;采用闭环肌松靶控注射系统进行罗库溴铵给药及肌松监测,T1%做为肌松监测值,监测罗库溴铵起效时间(注罗库溴铵毕到T1%降至0的时间),10%恢复时间(注罗库溴铵毕到T1%恢复至10%的时间),恢复指数(T1%恢复到25%至75%的时间),并记录两组患者术中麻醉药物用量。结果两组患者术前电解质、肝肾功能和术中不同时点HR、MAP、SpO 2差异无统计学意义。与NC组比较,C组罗库溴铵起效时间明显延长(P<0.05),10%恢复时间明显缩短(P<0.05),罗库溴铵用量明显增多,平均输注速率明显增快(P<0.05)。两组恢复指数、丙泊酚、瑞芬太尼、右美托咪定用量差异无统计学意义。结论新辅助化疗后行乳腺癌根治手术的患者术中罗库溴铵起效时间明显延长,10%恢复时间明显缩短,且罗库溴铵用量明显增多。

Objective To investigate the effect of neoadjuvant chemotherapy on the rocuronium muscle relaxation in breast cancer patients.Methods Sixty female patients with breast cancer scheduled for radical mastectomy under general anesthesia in our hospital from July 2018 to February 2019 were selected,aged 29-60 years,BMI 18-29 kg/m^2,falling into ASA physical statusⅠorⅡ.According to whether they had received neoadjuvant chemotherapy before surgery,they were divided into chemotherapy group(group C)and non-chemotherapy group(group NC),with 30 patients in each group.Patients in group C received 4 cycles of chemotherapy with adriamycin combined with taxol(AT)or adriamycin and cyclophosphamide combined with taxol(AC-T)treatment before surgical,while group NC received surgery directly without neoadjuvant chemotherapy.Preoperative electrolyte,liver and kidney function,HR,MAP and SpO 2 at the time of entering the room,immediate time of intubation,and when T1%recovered to 10%,25%and 75%of the two groups were recorded.Closed-loop muscle relaxant target control injection system was adopted for rocuronium dosing and monitoring muscle relaxant,T1%value was applied as a muscle relaxant monitor to measure the onset time of rocuronium bromide(time from rocuronium bromide injection end to T1%reduction until 0),10%recovery time(time from rocuronium bromide injection end to T1%recovered 10%),recovery index(time ranges that T1%recovered from^25%to 75%).Intraoperative anesthetic drug dosage was recorded in both groups as well.Results There was no statistically significant difference in electrolyte,liver and kidney function between two groups before operation.There was no statistically significant difference in HR,MAP and SpO 2 at each time point during operation as well.Compared with the group NC,the onset time of rocuronium bromide in Group C was significantly longer(P<0.05),and 10%recovery time was significantly shortened(P<0.05).There was no statistically significant difference in recovery index between two groups.Compared with the group NC,the dosage of rocuronium in group C was significantly increased,and the average infusion rate was significantly increased(P<0.05),while the dosage of propofol,remifentanil and dexmedetomidine showed no statistically significant difference.Conclusion In patients undergoing radical breast cancer surgery after neoadjuvant chemotherapy,the onset time of rocuronium was significantly longer,10%recovery time was significantly shorter,and the dosage of rocuronium increased significantly.