【作者】 代冬梅；

【导师】 吴洪翔；

【作者基本信息】 昆明医学院 ， 麻醉学， 2003， 硕士

【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。更多还原

【Abstract】 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 afterinduction 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.更多还原