不同麻醉方法和FDP对化疗后乳腺癌患者血液流变学的影响
|
摘要
目的：了解化疗后的乳腺癌患者麻醉过程中血液流变学的变化情况，摸索其相应的治疗措施，以求提高麻醉手术的安全性。方法：75例乳腺癌患者，分为A、B两组。A组为化疗组，45例，术前均接受三个疗程的化疗；B组为非化疗组，30例，术前未给予化疗。A组再随机分为三个亚组，每组15例，AⅠ组为单纯全麻组；AⅡ组为全麻复合硬膜外组；AⅢ组为全麻复合硬膜外麻醉加用1.6—二磷酸果糖组。所有病例均于麻醉前和麻醉诱导后1小时各抽取外周静脉血5ml作血液流变学有关指标检测。结果：A组患者麻醉前红细胞变形指数降低，刚性指数及全血粘度升高，与B组相比有显著差异(p＜0.05)。AⅡ麻醉后红细胞变形指数增加；全血粘度、血浆粘度、红细胞压积和红细胞聚集指数均下降；组内前后相比差异非常显著(p＜0.01)；而AⅠ麻醉后只有全血粘度、红细胞压积降低，组内前后比较差异非常显著(p＜0.01)；AⅢ组麻醉后红细胞变形指数增加与其它各组相比差异非常显著(p＜0.01)。结论：经术前化疗的乳腺癌患者存在着以红细胞变形力下降为特征的血液流变学变化，全麻复合硬膜外麻醉可为这类患者手术时的最佳麻醉选择；加用1.6—二磷酸果糖可进一步改善患者血液流变特性，有利于安全渡过围术期。
Objective: To observe the haemorrheologic change perioperatively in the patients who suffered from breast cancer and received preoperative chemotherapy. Methods: 75 cases scheduled for elective radical mastectomy, were divided into two groups. Group A (n=45), all patients received 3 courses of chemotherapy preoperatively; group B (n=30), patients received no chemotherapy. The group A was subdivided randomly into three subgroups: group AI, general anesthesia was administered; group AⅡ, general anesthesia combined with epidural block was administered; group AⅢ, patients received general anesthesia combined epidural block and fructose 1,6-diphosphate(FDP) was administered, 5ml venous blood was drawn to analyze the haemorrheologic change before anesthesia and 60 minutes after
induction of anesthesia respectively. Results: 1. The index of erythrocyte deformability of group A was lower markedly than that of group B. The index of erythrocyte rigidity and the blood viscosity of group A were higher than those of group B (p<0.05). 2. In group AⅡ, the index of erythrocyte deformability increased markedly, and the blood viscosity, plasma viscosity, the index of erythrocyte aggregation, HCT decreased after anesthesia (p<0.05), but in group AI only blood viscosity and HCT decreased(p<0.05). 3. The index of erythrocyte deformability of group AⅢ was higher than that of group AⅡ after anesthesia (p<0.05). Conclusion: The index of erythrocyte deformability was lower in the breast cancer patients after preoperative chemotherapy. Epidural block combined with general anesthesia may improve the haemorrheology of breast cancer patients. FDP is beneficial to improve haemorrheolgic condition.
Objective: To observe the haemorrheologic change perioperatively in the patients who suffered from breast cancer and received preoperative chemotherapy. Methods: 75 cases scheduled for elective radical mastectomy, were divided into two groups. Group A (n=45), all patients received 3 courses of chemotherapy preoperatively; group B (n=30), patients received no chemotherapy. The group A was subdivided randomly into three subgroups: group AI, general anesthesia was administered; group AⅡ, general anesthesia combined with epidural block was administered; group AⅢ, patients received general anesthesia combined epidural block and fructose 1,6-diphosphate(FDP) was administered, 5ml venous blood was drawn to analyze the haemorrheologic change before anesthesia and 60 minutes after
induction of anesthesia respectively. Results: 1. The index of erythrocyte deformability of group A was lower markedly than that of group B. The index of erythrocyte rigidity and the blood viscosity of group A were higher than those of group B (p<0.05). 2. In group AⅡ, the index of erythrocyte deformability increased markedly, and the blood viscosity, plasma viscosity, the index of erythrocyte aggregation, HCT decreased after anesthesia (p<0.05), but in group AI only blood viscosity and HCT decreased(p<0.05). 3. The index of erythrocyte deformability of group AⅢ was higher than that of group AⅡ after anesthesia (p<0.05). Conclusion: The index of erythrocyte deformability was lower in the breast cancer patients after preoperative chemotherapy. Epidural block combined with general anesthesia may improve the haemorrheology of breast cancer patients. FDP is beneficial to improve haemorrheolgic condition.
引文
1 陈筠，赵光瑜，代冬梅，等．恶性瘤病人术前化疗后氧自由基及红细胞改变．云南医药，1998，19：209．
2 赵昕，文宗曜，冯维原，等．急性白血病患者治疗前后红细胞变形性研究．中华血液学．1996，17-373
3 Bekyarova, G, Yankova, T and Kozarev, I etc. Reduced erythrocyte deformability related to activated lipid peroxidation during the early postburn period. Burns. 1996 Jun, 22(4): 291-4.
4 董伟，单毅．脓毒症大鼠红细胞变形能力的研究．中华实验外科杂志．1997，14(6)：334—335
5 Chung T. -W. and Ho C.-P. Changes in Viscosity of low shear rates and viscoelastic properties of oxidative erythrocyte suspensions. Clin Hemorheol Microcirc. 1999, 21: 99—103
6 金永娟．红细胞流变学．引自赵春亭，赵子文．主编．临床血液流变学．1997，北京：人民卫生出版社，48—52．
7 王天佑主编．血液流变学，1998，中国血液流变学杂志社．30—32
8 Weiss DJ and Evanson OA. Effects of sodium and potassium concentrations and PH on equine erythrocyte volume and deformability. Haematol. Int. 1997, 7: 37-41.
9 Muller G·H. effect of selective alteration of membranous or cytoplasmic properties on erythrocyte elongation in shear flow. Biorheology 1997, 34: 85-98.
10 喻田，余志豪，林光，等．异丙酚诱导及维持麻醉对血液流变学的影响．中华麻醉学杂志，1997，09，20；17(9)：562—563
11 崔乃杰，王兵主编．实用危重病急救医学，1993，天津：天津科技翻译出版公司，240—242
12 杨春艳，王春燕．芬太尼对血液流变学的影响，山西医科大学学报，1998，03，26；29(1)：32—33
13 王丽萍，赵作光，高凤和，等．高血压患者硬膜外麻醉前后血液流变学的变化．中华麻醉学杂志，1997，09，20；17(9)：568—569
14 程桥，杨拔贤．不同麻醉方法对全髋置换术患者的血液流变学的影响．临床麻醉学杂志，1999，02，25：15(1)：11—13
15 张咸伟，巴秀云，金士翱．麻醉诱导和维持期间人体血液流变学的变化．中华麻醉学杂志，1994，14：4—5
16 王迪芬，刘兴敏，付原，等．乳腺癌根治术患者围术血液流变学及血糖监测．贵阳医学院学报，1997，22：369—371
17 许学兵．1．6—二磷酸果糖在麻醉领域的应用．国外医学·麻醉学与复苏分册．1998，10，15；19(5)：272—275
18 汤宁，汪丽娟，吕杰胜，等．等容血液稀释和1．6—二磷酸果糖对兔缺血再灌注心肌的保护作用．河南医科大学学报，1996，12；3(4)；21—24．
19 阎淑枝，李敏，肖家思，等．1．6—二磷酸果糖对烧伤大鼠心功能和血液流变学的影响机制，心功能杂志，1997，06，25；9(2)：65—68
2 赵昕，文宗曜，冯维原，等．急性白血病患者治疗前后红细胞变形性研究．中华血液学．1996，17-373
3 Bekyarova, G, Yankova, T and Kozarev, I etc. Reduced erythrocyte deformability related to activated lipid peroxidation during the early postburn period. Burns. 1996 Jun, 22(4): 291-4.
4 董伟，单毅．脓毒症大鼠红细胞变形能力的研究．中华实验外科杂志．1997，14(6)：334—335
5 Chung T. -W. and Ho C.-P. Changes in Viscosity of low shear rates and viscoelastic properties of oxidative erythrocyte suspensions. Clin Hemorheol Microcirc. 1999, 21: 99—103
6 金永娟．红细胞流变学．引自赵春亭，赵子文．主编．临床血液流变学．1997，北京：人民卫生出版社，48—52．
7 王天佑主编．血液流变学，1998，中国血液流变学杂志社．30—32
8 Weiss DJ and Evanson OA. Effects of sodium and potassium concentrations and PH on equine erythrocyte volume and deformability. Haematol. Int. 1997, 7: 37-41.
9 Muller G·H. effect of selective alteration of membranous or cytoplasmic properties on erythrocyte elongation in shear flow. Biorheology 1997, 34: 85-98.
10 喻田，余志豪，林光，等．异丙酚诱导及维持麻醉对血液流变学的影响．中华麻醉学杂志，1997，09，20；17(9)：562—563
11 崔乃杰，王兵主编．实用危重病急救医学，1993，天津：天津科技翻译出版公司，240—242
12 杨春艳，王春燕．芬太尼对血液流变学的影响，山西医科大学学报，1998，03，26；29(1)：32—33
13 王丽萍，赵作光，高凤和，等．高血压患者硬膜外麻醉前后血液流变学的变化．中华麻醉学杂志，1997，09，20；17(9)：568—569
14 程桥，杨拔贤．不同麻醉方法对全髋置换术患者的血液流变学的影响．临床麻醉学杂志，1999，02，25：15(1)：11—13
15 张咸伟，巴秀云，金士翱．麻醉诱导和维持期间人体血液流变学的变化．中华麻醉学杂志，1994，14：4—5
16 王迪芬，刘兴敏，付原，等．乳腺癌根治术患者围术血液流变学及血糖监测．贵阳医学院学报，1997，22：369—371
17 许学兵．1．6—二磷酸果糖在麻醉领域的应用．国外医学·麻醉学与复苏分册．1998，10，15；19(5)：272—275
18 汤宁，汪丽娟，吕杰胜，等．等容血液稀释和1．6—二磷酸果糖对兔缺血再灌注心肌的保护作用．河南医科大学学报，1996，12；3(4)；21—24．
19 阎淑枝，李敏，肖家思，等．1．6—二磷酸果糖对烧伤大鼠心功能和血液流变学的影响机制，心功能杂志，1997，06，25；9(2)：65—68