术前化疗对肿瘤切除术患者术中血流动力学及术后早期恢复质量的影响

Effect of preoperative chemotherapy on intraoperative hemodynamics and quality of early postoperative recovery in patients undergoing tumor resection

目的评价术前化疗对肿瘤切除术患者术中血流动力学及术后早期恢复质量的影响。方法本研究为前瞻性队列研究。选择2023年1月至2023年8月在新疆医科大学附属肿瘤医院行恶性肿瘤切除术患者249例,根据纳入患者有无化疗史分为化疗组(C组,n=104)和非化疗组(N组,n=145)。于入室(T_(0))、气管插管前1 min(T_(1))、气管插管后即刻(T_(2))、切皮(T_(3))、切皮后30 min(T_(4))、手术结束(T_(5))和术后24 h(T_(6))时记录HR和MAP,T_(6)时记录患者恢复质量-15量表(QoR-15)评分,气管拔管后观察低氧血症、置入口咽通气道、呛咳、误吸发生情况,记录术后恶心呕吐(PONV)发生情况。结果与N组比较,C组患者MAP T_(1)时降低,T_(2,3)时升高,T_(2-5)时HR升高,T_(6)时QoR-15总评分、术后身体舒适度评分、情绪状态评分、疼痛评分降低,气管拔管后低氧血症和PONV发生率升高(P<0.05)。结论术前化疗可影响肿瘤切除术患者术中血流动力学稳定,术后早期恢复质量降低。

Objective:To evaluate the effect of preoperative chemotherapy on the intraoperative hemodynamics and quality of early postoperative recovery in patients undergoing tumor resection.Methods:This was a prospective cohort study.A total of 249 patients undergoing malignant tumor resection in the Affiliated Cancer Hospital of Xinjiang Medical University from January to August 2023 were divided into chemotherapy group(group C,n=104)and non-chemotherapy group(group N,n=145)based on their chemotherapy history.Heat rate and mean arterial pressure were recorded on admission(T_(0)),1 min before endotracheal intubation(T_(1)),immediately after endotracheal intubation(T_(2)),at skin resection(T_(3)),30 min after endotracheal incision(T_(4)),at the end of surgery(T_(5))and 24 h after surgery(T_(6)),and the Quality of Recovery-15 score was recorded at T_(6).The occurrence of hypoxemia,oropharyngeal airway implantation,bucking and aspiration after tracheal extubation was observed.The occurrence of postoperative nausea and vomiting was recorded.Results:Compared with group N,the mean arterial pressure was significantly decreased at T_(1) and increased at T_(2,3),the heart rate was increased at T_(2-5),the total Quality of Recovery-15 score,postoperative physical comfort score,emotional state score and pain score were decreased at T_(6),and the incidence of hypoxemia and postoperative nausea and vomiting after tracheal extubation was increased in group C(P<0.05).Conclusions:Preoperative chemotherapy can affect the intraoperative hemodynamic stability and the quality of early postoperative recovery is decreased in patients undergoing preoperative tumor resection.