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

作　　者：王凯[1] 杨桐榉[1] 王丽君[1] 王震[1] 陈力勇[1] WANG Kai;YANG Tongju;WANG Lijun;WANG Zhen;CHEN Liyong(Department of Anesthesiology,Institute of Surgery Research,Third Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]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,重庆400042

出　　处：《第三军医大学学报》2019年第1期85-90,共6页Journal of Third Military Medical University

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. 2μg/m L)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/m L,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/m L,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。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 anal

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-β1 

分 类 号：R446.112[医药卫生—诊断学] R614[医药卫生—临床医学]