■癌症化学治疗剂引起对神经肌肉阻断药物的反应改变,这可能会对围手术期产生严重影响。镁,通常发现这些患者缺乏,在神经肌肉传递中起着不可或缺的作用。本研究旨在了解新辅助化疗对顺式阿曲库铵神经肌肉阻滞特性的影响。
■将100名计划进行乳腺癌手术的女性患者分为两组(每组50名)。B组接受紫杉烷的新辅助化疗,阿霉素,和环磷酰胺,A组未接受新辅助化疗。在尺神经处使用周围神经刺激器测量顺式阿曲库铵0.15mg/kg后的神经肌肉阻滞。发病时间,强烈阻滞的持续时间,临床作用持续时间,顺阿曲库铵最后一次给药后TOF4的时间,同时测定术前血清镁浓度。相关性和多元回归分析新辅助化疗史与化疗史、术前镁,以及上述时间点。进行中介分析以确定镁是否介导观察到的效果。
■与A组相比,B组的发病时间延长了近18%(P=0.001)。强效阻滞时间B组为35.27±8.9min,A组为42.07±10.99min(P<0.001)。顺式阿曲库铵的临床作用时间在B组(46.06±8.68分钟)明显短于A组(55.87±11.04分钟,P<0.001)。B组达到TOF4的时间为32.86±5.66min,A组为36.57±8.49min(P<0.05)。B组术前血清镁水平明显降低(P<0.001)。
■接受新辅助化疗的患者出现延迟发作,行动持续时间较短,和更快的回收顺式阿曲库铵。虽然B组术前镁水平较低,发现它是这些影响的独立预测因子,而不是中介因子。
UNASSIGNED: Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of
cisatracurium.
UNASSIGNED: One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following
cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of
cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects.
UNASSIGNED: Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of
cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001).
UNASSIGNED: Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for
cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.