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胸椎旁阻滞-丙泊酚复合全麻对肺癌手术患者血清VEGF-C、TGF-β1的影响
Effect of thoracic paravertebral block-propofol intravenous balance general anesthesia on serum vascular endothelial growth factor C and transforming growth factor β1 in patients undergoing radical lung cancer resection
- 第三军医大学学报 2019年41卷第1期 页码：85-90
- 作者机构：
400042 重庆，陆军军医大学(第三军医大学)第三附属医院(野战外科研究所)麻醉科
- 作者简介：
[ 陈力勇，E-mail: mzkcly@aliyun.com CHEN Liyong, E-mail: mzkcly@aliyun.com
- 基金信息：
DOI：10.16016/j.1000-5404.201808148
中图分类号： R446.112;R614;R734.2收稿：2018-08-23，
修回：2018-09-23，
纸质出版：2019-01-15
- 稿件说明：
移动端阅览
王凯, 杨桐榉, 王丽君, 等. 胸椎旁阻滞-丙泊酚复合全麻对肺癌手术患者血清VEGF-C、TGF-β1的影响[J]. 第三军医大学学报, 2019,41(1):85-90.
Kai WANG, Tongju YANG, Lijun WANG, et al. Effect of thoracic paravertebral block-propofol intravenous balance general anesthesia on serum vascular endothelial growth factor C and transforming growth factor β1 in patients undergoing radical lung cancer resection[J]. Journal of Third Military Medical University, 2019, 41(1): 85-90.
王凯, 杨桐榉, 王丽君, 等. 胸椎旁阻滞-丙泊酚复合全麻对肺癌手术患者血清VEGF-C、TGF-β1的影响[J]. 第三军医大学学报, 2019,41(1):85-90. DOI： 10.16016/j.1000-5404.201808148.
Kai WANG, Tongju YANG, Lijun WANG, et al. Effect of thoracic paravertebral block-propofol intravenous balance general anesthesia on serum vascular endothelial growth factor C and transforming growth factor β1 in patients undergoing radical lung cancer resection[J]. Journal of Third Military Medical University, 2019, 41(1): 85-90. DOI： 10.16016/j.1000-5404.201808148.
摘要
目的
2
比较胸椎旁神经阻滞-丙泊酚静脉复合全麻(paravertebral nerve block-propofol intravenous balance general anesthesia
PPA)和七氟醚吸入复合全麻(sevoflurane inhalation balanced general anesthesia
SGA)对肺癌根治术患者血清VEGF-C、TGF-β1表达的影响。
方法
2
将肺癌根治术患者分成PPA组(
n
=23)和SGA组(
n
=23)。PPA组全麻诱导前行胸椎旁神经阻滞，给予0.5%罗哌卡因(2 mg/kg)，术中靶控输注丙泊酚(血浆浓度2.6~3.2 μg/mL)和瑞芬太尼维持；SGA组术中予以七氟醚(1.0~1.5倍最低有效肺泡浓度)和瑞芬太尼维持。观察两组患者术中和术后24 h阿片类药物用量，术后2、8、24、48、72 h疼痛评分，以及术前和术后24 h血清VEGF-C、TGF-β1浓度。
结果
2
PPA组术中瑞芬太尼使用量显著少于SGA组(
P
<
0.01)，术后24 h舒芬太尼使用量显著少于SGA组(
P
<
0.01)，术后2、8、24 h VAS评分显著低于SGA组(
P
<
0.01)。术后24 h血清VEGF-C浓度PPA组明显低于SGA组[(629±203)
vs
(908±222) pg/mL
P
=0.030
]
，血清TGF-β1浓度PPA组也明显低于SGA组[(8.37±2.84)
vs
(10.57±2.47) ng/mL
P
=0.021
]
。
结论
2
胸椎旁神经阻滞-丙泊酚静脉复合全麻能降低肺癌根治术患者阿片类药物用量，改善其术后镇痛效果，降低其术后血清中肿瘤血管生成相关因子浓度。
Abstract
Objective
2
To compare the effects of thoracic paravertebral nerve block-propofol intravenous balance general anesthesia (PPA) and sevoflurane inhalation balanced general anesthesia (SGA) on the serum concentrations of vascular endothelial growth factor C (VEGF-C) and transforming growth factor β1 (TGF-β1) in the patients undergoing radical resection for non-small cell lung cancer performed
via
video-assisted thoracoscopy.
Methods
2
Lung cancer patients undergoing radical resection were assigned to the PPA(
n
=23) or SGA(
n
=23) group. In the PPA group
thoracic paravertebral nerve block anesthetic was performed successfully with local injection of 0.5%ropivacaine(2.0 mg/kg) before induction of anesthesia
anesthesia was maintained with the target controlled infusion (TCI) of propofol (plasma concentration of 2.6~3.2 μg/mL)and intravenous remifentanil. In the SGA group
anesthesia was maintained with 1.0~1.5 (minimum alveolar concentration
MAC) sevoflurane and intravenous remifentanil. We observed opioid consumption intraoperative and 24 h postoperative
the pain scores at 2
8
24
48
72 h after surgery
as well as the serum concentrations of VEGF-C and TGF-β1 before surgery and 24 h after surgery.
Results
2
The amount of intraoperative remifentanil consumption in the PPA group was significantly lower than in the SGA group (
P
<
0.01)
the amount of sufentanil consumption at 24 h postoperatively was significantly lower than in the SGA group (
P
<
0.01)
and the VAS score at 2
8 and 24 h postoperatively was significantly lower than in the SGA group (
P
<
0.01). At 24 h after surgery
the serum VEGF-C levels were lower in group PPA compared with the group SGA (629±203
vs
908±222 pg/mL
P
=0.030)
the serum TGF-β1 levels were lower in group PPA compared with the group SGA (8.37±2.84
vs
10.57±2.47 ng/mL
P
=0.021).
Conclusion
2
Thoracic paravertebral nerve block-propofol intravenous balance general anesthesia can reduce opioids consumption for patients undergoing radical surgery for lung cancer
improve the postoperative analgesic effect
and reduce the concentration of serum tumor angiogenesis-related factors at 24 h after surgery. It is suggested that thoracic paravertebral nerve block-propofol intravenous balance general anesthesia is better than sevoflurane inhalation balanced general anesthesia for lung cancer patients undergoing radical resection.
关键词
Keywords
references
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