新辅助化疗对乳腺癌患者靶控输注异丙酚意识消失时半数有效效应室靶浓度的影响

目的 探讨新辅助化疗对乳腺癌患者靶控输注异丙酚意识消失时半数有效效应室靶浓度(EC50)的影响.方法 择期拟行乳腺癌切除术患者90例,女性,ASAⅠ或Ⅱ级,年龄30～60岁,体重指数<30kg/m2,根据术前是否接受新辅助化疗及其化疗方案分为3组(n=30),未化疗组(Ⅰ组)术前不使用任何化疗药物;紫杉醇化疗组(Ⅱ组)及环磷酰胺+阿霉素+5-氟尿嘧啶联合化疗组(Ⅲ组)均进行4个疗程化疗,并于第4个疗程结束后10～15d时行乳腺癌切除术.麻醉诱导:靶控输注异丙酚,按序贯法确定异丙酚的效应室靶浓度,第1例患者异丙酚效应室靶浓度为2.07μg/ml,各相邻靶浓度之比为1.09.以睫毛反射消失及对言语指令无反应作为判断意识消失的标志.若患者意识消失,则持续靶控输注该浓度异丙酚,并静脉注射芬太尼3μg/kg及罗库溴铵0.6 mg/kg后气管插管;若患者意识未消失,则停止靶控输注,静脉注射异丙酚2mg/kg、芬太尼3μg/kg及罗库溴铵0.6 mg/kg后气管插管.计算靶控输注异丙酚意识消失时的EC50.结果 与Ⅰ组比较,Ⅱ组及Ⅲ组患者靶控输注异丙酚意识消失时的EC50.均降低(P<0.05),Ⅱ组和Ⅲ组间上述指标差异无统计学意义(P>0.05).结论 新辅助化疗可降低乳腺癌患者靶控输注异丙酚意识消失时的EC50.

Effect of neoadjuvant chemotherapy on EC50 of propofol administered by TCI causing loss of consciousness in breast cancer patients

Objective To investigate the effect of neoadjuvant chemotherapy on EC50 of propofol given by TCI which produces loss of consciousness (LOC) in breast cancer patients.Methods Ninety ASA Ⅰ or Ⅱ breast cancer patients aged 30-60 yr scheduled for elective surgery were allocated into 3 groups according to the chemotherapy the patients received (n=30 each):group Ⅰ control (group C) received no chemotherapy;group Ⅱ taxol and group Ⅲ adriamycine+cyclophosphamide+5-Fu.The patients were unpremedicated.The EC50 of propofol given by TCI was determined by up-and-down technique.The initial effect-site concentration (Ce) of propofol was 2.07μg/ml and the ratio between the 2 successive Ce was 1.09.Loss of response to verbal command and eyelash stimulation was used as sighs of LOC.The EC50 of propofol was calculated.Results The EC50 of propofol causing LOC was significantly lower in group Ⅱ and Ⅲ than in control group.There was no significant difference in the EC50 of propofol which produces LOC between group Ⅱ and Ⅲ.Conclusion The EC50 of propofol causing LOC in breast cancerpatients is decreased by adjuvant chemotherapy.