新辅助化疗后胃癌手术七氟醚最低肺泡有效浓度的测定

Determination of the minimum alveolar concentration of sevoflurane in patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy

中文关键词: 新辅助化疗  外科切皮  七氟醚  最低肺泡有效浓度

英文关键词: Neoadjuvant chemotherapy  Surgical incision  Sevoflurane  Minimum alveolar concentration

中文摘要:

      目的 确定接受新辅助化疗后1个月行胃癌根治术的患者全凭吸入麻醉时外科切皮无体动反应的七氟醚最低肺泡有效浓度(minimum alveolar concentration, MAC)。方法 择期行胃癌根治术患者25例, 男14例, 女11例, 年龄30～50岁, ASA Ⅰ 或 Ⅱ 级, 于手术1个月前结束2个周期的奥沙利铂复合替吉奥化疗(1个化疗周期为14 d)。吸入6％七氟醚全麻诱导, 至患者意识消失行气管插管术后, 将呼气末七氟醚浓度调整至预定值, 维持15 min不变, 然后外科切皮。根据Dixon上下法进行试验, 初始呼气末七氟醚浓度为2.2％, 切皮时发生体动反应, 下一例升高一个浓度梯度, 切皮时未发生体动反应, 下一例降低一个浓度梯度, 相邻浓度梯度为0.2％。采用Probit分析计算出七氟醚的MAC和95％ CI。结果 本研究中进行外科切皮操作时, 患者的体动反应表现为肢体轻微活动, 所有患者均未发生身体大幅扭动、睁眼或术中知晓等严重并发症。有11例(44％)患者发生体动。接受新辅助化疗的胃癌患者在外科切皮时无体动反应的七氟醚MAC值为1.52％, 95％ CI为1.37％～1.65％。结论 接受新辅助化疗的胃癌患者切皮无体动反应的七氟醚的MAC值为1.52％。

英文摘要:

      Objective To determine the minimum alveolar concentration (MAC) of sevoflurane for blunting the responses to surgical incision in 50％ adult patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy. Methods Twenty-five ASA physical statusⅠ or Ⅱ,and aged 30-50 years patients (14 males and 11 females) diagnosed with gastric carcinoma were enrolled. At least 1 month before the operation, all these patients received 2 cycles (1 chemotherapy cycle was 14 days) of chemotherapy including oxaliplatin and tegafur. At first, the anesthesia induction was started by inhaling 6％ sevoflurane. After the patient lost consciousness, the endotracheal intubation was performed. And then, the end tidal sevoflurane concentration was adjusted to the target concentration and maintained stable for 15 min. After that, the surgical incision was executed. The Dixon’s up-and-down method was used to calculate the MAC. The initial end tidal sevoflurane concentration was 2.2％ and it was increased or decreased by 0.2％ in the next patient according to the surgical incision response. If the surgical incision response was positive, the end tidal sevoflurane concentration was increased; if the surgical incision response was negative, the end tidal sevoflurane concentration was decreased. The midpoint from negative response to positive response was set as the balance point and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MAC. Results Minor physical activity occurred when the surgical incision started. No body twisting, eye opening or intraoperative awareness occurred. Body moving occurred in 11 patients (44%) when the surgical incision started. The end tidal sevoflurane concentration for blunting the responses to surgical incision in 50％ adult patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy was 1.52％, and the 95％ CI was 1.37％-1.65％. Conclusion The MAC of sevoflurane for blunting the responses to surgical incision in 50％ adult patients diagnosed as gastric carcinoma and treated with neoadjuvant chemotherapy is 1.52％.