麻醉处理对蒽环类抗肿瘤药物心脏毒性影响的研究进展.pdfVIP

中国肿瘤临床2013年第40卷第22期 Chin J Clin Oncol 2013,Vol.40,N 1415 麻醉处理对蒽环类抗肿瘤药物心脏毒性影响的 研究进展 赵洪伟 综述 李锦成 审校 摘要 蒽环类抗肿瘤药物是一类对造血系统和实体肿瘤具有高效作用的广谱抗癌药物，是临床化疗方案中常用的药物之 一。该类药物有一个严重的不良反应，即随着剂量的增加会产生显著的心脏毒性。临床上应用具有心肌保护作用的药物是安全 使用蒽环类药物的重要策略之一。很多癌症患者在化疗期间还要进行手术治疗，全身麻醉是患者手术时主要的麻醉方法。对术 前已行蒽环类药物化疗的患者实施全麻手术时，可能正处于蒽环类药物所致心肌损害的急性或慢性期，而麻醉药物对蒽环类药 物所致心脏毒性的影响，将对患者术后心肺功能的恢复产生重要作用。目前，有关麻醉药物对蒽环类药物心脏毒性的影响已开 始受到关注，本文即从蒽环类抗肿瘤药物的心脏毒性、心肌保护以及麻醉药物对其心脏毒性影响的研究现况进行综述。 关键词 蒽环类药物 心脏毒性 心肌保护 全麻 麻醉药物 doi:10.3969/j.issn.1000-8179 Research progress on the effect of anesthesia on anthracycline car- diotoxicity Hongwei ZHAO, Jincheng LI Correspondence to: Jincheng LI; E-mail: lijchengg@163.com Department of Anesthesiology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Center of Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin 300060, China. Abstract Anthracycline-based antitumor drugs are one of the highly effective broad-spectrum anti-cancer drugs that are commonly used clinically. However, anthracyclines have the serious side effect of cumulative dose-related cardiotoxicity. Clinically, intake of myocardial protective drugs is one of the most important strategies for the safe use of anthracyclines in chemotherapy. Numerous cancer patients un- dergoing chemotherapy also require surgery, during which general anesthesia is commonly used. Various studies have shown that propofol and sevoflurane, the most commonly used general anesthetics, present a significant protective effect in myocardial ischemia –reperfusion damage. Therefore, for patients who have just undergone chemotherapy with anthracyclines, anthracycline-induced myocardial injury may occur at the acute or chronic phase of surgery. Consequently, if the effect of anesthetics on the cardiotoxicity of anthracyclines is simi