乳腺癌新辅助化疗后不同麻醉方式对心电图QTc及QTcd的影响  

Comparison of the effect of different anesthesia methods on QT interval and QT dispersion in patients undergoing radical mastectomy after neoadjuvant chemotherapy

作　　者：高健[1] 杨碎胜[2] 赵栋[1] 

机构地区：[1]甘肃省肿瘤医院麻醉科,甘肃兰州730050 [2]甘肃省肿瘤医院乳腺科,甘肃兰州730050

出　　处：《甘肃医药》2013年第8期572-574,共3页Gansu Medical Journal

摘　　要：目的：比较安氟醚和丙泊酚对新辅助化疗后乳腺癌根治术患者心电图QTc及QTcd的影响。方法：104例Ⅱ或Ⅲ期乳腺癌患者接受新辅助化疗后行乳腺癌改良根治术,术前按麻醉方式随机分为2组,分别为安氟醚组（AE）和丙泊酚组（AP）。两组静脉快速诱导插管机械通气后,AE组同时吸入1.5%~2%安氟醚,AP组仅静脉靶控输注丙泊酚。记录化疗前（Tl）、化疗结束后（T2）、气管插管前（T3）、气管插管后即刻（T4）、吸入安氟醚或静脉输注丙泊酚5、30min拔除气管导管后10min（T5-7）时QT间期和RR间期,再换算出相应的QTc和QTcd。结果：与T1比较,AE组T6的QTc延长（P〈0.05）;两组T2-7的QTcd分别明显增加（P〈0.05）。与T2比较,AE组T5-6时点的QTcd明显增加（P〈0.05）。与AP组比较,AE组T4-6的QTc、QTcd均有所延长（P〈0.05）;结论：接受新辅助化疗的乳腺癌患者QT间期和QT离散度可增加;安氟醚可进一步延长术前接受新辅助化疗乳腺癌患者的QT间期和QT离散度,而丙泊酚对此没有明显作用;全凭静脉丙泊酚麻醉可以作为新辅助化疗后乳腺癌根治术麻醉的良好选择。Objective：To compare the effect and variation tendency of QT interval and QT dispersion by using propofol and enflurane on in patients undergoing radical mastectomy after neoadjuvant chemotherapy. Methods ：104 staged 11 or NI breast cancer received neoadjuvant chemotherapy before radical mastectomy were randomly divided into two groups：group AE and group AP. Anesthesia was induced and maintained with 1.5%-2% enflurane in group AE and propofol via TCI in group AP. QT and RR interval were recorded before chemotherapy（Tt）, the time after chemotherapy （T2）, the time before trached intubation （T3）, the time after trached intubation （T4）, at 5 and 30rain of inhalation of enflurane or intravenous infusion of propofol and at 10 min after tracheal extubation （T5-7）, QTc and QTcd were also calculated at different time. Results： QTc was signifieantly longer at T6 in group AE and QTcd longer at T2-7 in group AE and AP than at Tl in both group （P〈0.05）. QTed was significantly longer at T5-6 than at T2 in group AE （P〈0.05）,QTc and QTcd were significantly longer at T4-6 in group AE than at same time in group AP （P〈0.05）. Conelusion：QTc and QTcd of breast cancer patients with neoadjuvant chemotherapy are increase in which enflurane can further extend the breast cancer patient＇s QTc and QTcd, and propofol has no the effect like enflurane.Total intravenous anesthesia with propofol is better choice for the patients who pretreated with neoadjuvant chemotherapy and will undergoing radical mastectomy.

关 键 词：安氟醚 丙泊酚 新辅助化疗 乳腺癌 QT间期 QT离散度 

分 类 号：R737.9[医药卫生—肿瘤]