[1]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(01):85-90.
 WANG Kai,YANG Tongju,WANG Lijun,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].J Third Mil Med Univ,2019,41(01):85-90.
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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(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
41卷
期数:
2019年第01期
页码:
85-90
栏目:
临床医学
出版日期:
2019-01-15

文章信息/Info

Title:
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
作者:
王凯杨桐榉王丽君王震陈力勇
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
Author(s):
WANG KaiYANG TongjuWANG LijunWANG ZhenCHEN Liyong

Department of Anesthesiology, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University(Third Military Medical University), Chongqing, 400042, China

关键词:
胸椎旁神经阻滞丙泊酚静脉复合全麻肺癌根治术血管内皮生长因子-C转化生长因子-&beta1
Keywords:
thoracic paravertebral nerve blockpropofol intravenous balance general anesthesiaradical resection of pulmonary carcinoma vascular endothelial growth factor-Ctransforming growth factor-&beta1
分类号:
R446.112; R614; R734.2
文献标志码:
A
摘要:

目的    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    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    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    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   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    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       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    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.

参考文献/References:

[1]TORRE L A, BRAY F, SIEGEL R L, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108. DOI:10.3322/caac.21262.
[2]陈万青,孙可欣,郑荣寿,等.2014年中国分地区恶性肿瘤发病和死亡分析[J].中国肿瘤,2018,27(1):1-14.
CHEN W Q,SUN K X,ZHENG R S,et al.Report of cancer incidence and mortality in different areas of China,2014[J].Chin Cancer, 2018,27(1):1-14.
[3]SEKANDARZAD M W, VAN ZUNDERT A A J, LIRK P B, et al. Perioperative anesthesia care and tumor progression[J]. Anesth Analg, 2017, 124(5): 1697-1708. DOI:10.1213/ANE.0000000000001652.
[4]WIGMORE T J, MOHAMMED K, JHANJI S. Long-term survival for patients undergoing volatile versus Ⅳ anesthesia for cancer surgery: a retrospective analysis[J]. Anesthesiology, 2016, 124(1): 69-79. DOI:10.1097/ALN.00000000 00000936.
[5]KIM R. Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence[J]. J Transl Med, 2018, 16(1): 8. DOI:10.1186/s12967-018-1389-7.
[6]LI X X, LI R J, ZHAO L J, et al. Expression of molecular factors correlated with metastasis in small cell lung cancer and their significance[J]. Int J Clin Exp Pathol, 2015, 8(11): 14676-14684.
[7]LIU S G, YUAN S H, WU H Y, et al. The Clinical research of serum VEGF, TGFβ1, and endostatin in non-small cell lung cancer[J]. Cell Biochem Biophys, 2015, 72(1): 165-169. DOI:10.1007/s12013-014-0431-5.
[8]O’RIAIN S C, BUGGY D J, KERIN M J, et al. Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2[J]. Anesth Analg, 2005, 100(1): 244-249. DOI:10.1213/01.ANE.0000143336.37946.7D.
[9]XU Y J, CHEN W K, ZHU Y, et al. Effect of thoracic epidural anaesthesia on serum vascular endothelial growth factor C and cytokines in patients undergoing anaesthesia and surgery for colon cancer[J]. Br J Anaesth, 2014, 113(Suppl 1): i49-i55. DOI:10.1093/bja/aeu148.
[10]BUGGY D J, BORGEAT A, CATA J, et al. Consensus statement from the BJA workshop on cancer and anaesthesia[J]. Br J Anaesth, 2015, 114(1): 2-3. DOI:10.1093/bja/aeu262.
[11]WILDSMITH J A. Continuous thoracic epidural block for surgery: gold standard or debased currency[J]. Br J Anaesth, 2012, 109(1): 9-12. DOI:10.1093/bja/aes177.
[12]YEUNG J H, GATES S, NAIDU B V, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy[J]. Cochrane Database Syst Rev, 2016, 2: CD009121. DOI:10.1002/14651858.CD009121.pub2.
[13]陈凛,陈亚进,董海龙,等.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20. DOI:10.19538/j.cjps.issn10052208.2018.01.01.
CHEN L,CHEN Y J,DONG H L,et al.Chinese expert consensus and path management guidelines for accelerated rehabilitation surgery (2018 Edition)[J]. Chin J Prac Surg, 2018,38(1):1-20. DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.
[14]VOGT A. Paravertebral block—A new standard for perioperative analgesia[J]. Trends Anaesth Crit Care, 2013, 3(6): 331-335. DOI:10.1016/j.tacc.2013.07.004.
[15]USUDA K, IWAI S, FUNASAKI A, et al. Expression and prognostic impact of VEGF, CD31 and αSMA in resected primary lung cancers[J]. Anticancer Res, 2018, 38(7): 4057-4063. DOI:10.21873/anticanres.12695.
[16]DING G, LIU Y, LIANG C. Efficacy of radiotherapy on intermediate and advanced lung cancer and its effect on dynamic changes of serum vascular endothelial growth factor and matrix metalloproteinase9[J]. Oncol Lett, 2018, 16(1): 219-224. DOI:10.3892/ol.2018.8622.
[17]LAI Y, WANG X, ZENG T, et al. Serum VEGF levels in the early diagnosis and severity assessment of non-small cell lung cancer[J]. J Cancer, 2018, 9(9): 1538-1547. DOI:10.7150/jca.23973.
[18]MOK T, GORBUNOVA V, JUHASZ E,et al.A correlative biomarker analysis of the combination of bevacizumab and carboplatin-based chemotherapy for advanced nonsquamous non-small-cell lung cancer: results of the phase Ⅱ randomized ABIGAIL study (BO21015)[J].J Thorac Oncol,2014,9(6):848-855.DOI:10.1097/JTO.0000000000 000160.
[19]DUAN L, YE L, ZHUANG L,et al.VEGFC/VEGFR3 axis mediates TGFβ1induced epithelial-to-mesenchymal transition in non-small cell lung cancer cells[J].PLoS ONE,2018,13(7):e0200452.DOI:10.1371/journal.pone.0200452. eCollection 2018.
[20]陈冀衡,范志毅,张云霄,等.椎旁神经阻滞联合全麻与全麻下胸腔镜肺癌根治术病人肿瘤侵袭和转移风险的比较:VEGF和MMP-9血浓度[J].中华麻醉学杂志,2015,35(1):23-26. DOI:10.3760/cma.j.issn.0254-1416.2015.01.008.
CHEN J H,FAN Z Y,ZHANG Y X,et al. Comparison of risk of tumor invasion and metastasis under paravertebral block combined with general anesthesia versus general anesthesia in the patients undergoing radical lung cancer resection performed via videoassisted thoracoscope:plasma VEGF and MMP9[J]. Chin J Anesthesiol, 2015,35(1):23-26. DOI:10.3760/cma.j.issn.0254-1416.2015.01.008.
[21]KUSHIDA A, INADA T, SHINGU K. Enhancement of antitumor immunity after propofol treatment in mice[J]. Immunopharmacol Immunotoxicol, 2007, 29(3/4): 477-486. DOI:10.1080/08923970701675085 .
[22]SHI Q Y, ZHANG S J, LIU L, et al. Sevoflurane promotes the expansion of glioma stem cells through activation of hypoxiainducible factors in vitro[J]. Br J Anaesth, 2015, 114(5): 825-830. DOI:10.1093/bja/aeu402.
[23]BRACK A, RITTNER H L, STEIN C. Immunosuppressive effects of opioidsclinical relevance[J]. J Neuroimmune Pharmacol, 2011, 6(4): 490-502. DOI:10.1007/s11481011-9290-7.
[24]HOROWITZ M, NEEMAN E, SHARON E, et al. Exploiting the critical perioperative period to improve longterm cancer outcomes[J]. Nat Rev Clin Oncol, 2015, 12(4): 213-226. DOI:10.1038/nrclinonc.2014.224.
[25]PIEGELER T, VOTTA-VELIS E G, LIU G,et al.Antimetastatic potential of amidelinked local anesthetics: inhibition of lung adenocarcinoma cell migration and inflammatory Src signaling independent of sodium channel blockade[J]. Anesthesiology,2012,117(3):548-559.
[26]LIRK P, HOLLMANN M W, FLEISCHER M, et al. Lidocaine and ropivacaine, but not bupivacaine, demethylate deoxyribonucleic acid in breast cancer cells in vitro[J]. Br J Anaesth, 2014, 113(Suppl 1): i32-i38. DOI:10.1093/bja/aeu201.
[27]HOOIJMANS C R, GEESSINK F J, RITSKESHOITINGA M, et al. A systematic review and meta-analysis of the ability of analgesic drugs to reduce metastasis in experimental cancer models[J]. Pain, 2015, 156(10): 1835-1844. DOI:10.1097/j.pain.0000000000000296.
[28]KUN L, TANG L, WANG J, et al. Effect of combined general/epidural anesthesia on postoperative NK cell activity and cytokine response in gastric cancer patients undergoing radical resection[J]. Hepatogastroenterology, 2014, 61(132): 1142-1147.

更新日期/Last Update: 2019-01-14