不同麻醉方式对老年肺癌患者围术期血浆炎症因子表达的影响  

Effects of different anesthesia approaches on perioperative expression of serum inflammatory cytokines in elderly patients with lung cancer

作　　者：马静雅[1] 吴德华[1] 徐益萍[1] 吴蔚宇[1] 曹晖[1] 吴镜湘[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200032

出　　处：《中国临床医学》2016年第2期167-171,共5页Chinese Journal of Clinical Medicine

基　　金：上海市科学技术委员会医学重点项目(121411952000);上海市申康医学发展中心市级医院科技发展项目(SHDC12014241);上海交通大学附属胸科医院重大重点项目(2014YCDC20500)~~

摘　　要：目的：探讨不同麻醉方式对老年肺癌患者围术期血浆白介素-6（IL-6）、IL-8和IL-10表达的影响。方法：选择60例行标准肺癌根治术的老年（60-80岁）肺癌患者作为研究对象。所有患者美国麻醉医师协会（ASA）Ⅰ-Ⅱ级,随机分为：全麻组（G组）、全麻复合椎旁神经阻滞麻醉组（GP组）、全麻复合硬膜外阻滞麻醉组（GE组）,每组20例。分别于麻醉前（T0）、病灶切除后（T1）、拔除气管导管后（T2）及术后24h（T3）抽取静脉血,检测血浆中IL-6、IL-8和IL-10水平,统计围手术期并发症发生情况及预后。结果：与T0时间点相比,3组在T1-T3时间点血浆IL-6、IL-8、IL-10浓度进行性升高（P〈0.01）。与G组相比,T1-T3时间点GP组和GE组血浆IL-6浓度降低（P〈0.05）,T2-T3时间点GE组血浆IL-8浓度降低（P〈0.05）。G组患者总体并发症发生率（60%）高于GP组（30%）和GE组（25%,P〈0.05）。结论：与单纯全麻相比,全麻复合椎旁神经阻滞、全麻复合硬膜外阻滞可部分抑制老年肺癌患者围术期炎症因子的表达,有利于降低围术期并发症,改善患者预后。Objective： To investigate the effects of different anesthesia approaches on the perioperative expression of interleukin-6 （IL-6）, Ib8, and IL-10 in elderly patients with lung cancer. Methods： Sixty elderly patients, aged 60-80 years old, who underwent standard lung cancer radical operation, were selected. All the subjects were classified as ASA Ⅰ-Ⅱ and were randomly divided into 3 groups with 20 in each： general anesthesia group （group G）, general anesthesia combined with thoracic paravertebral block group （group GP）, general anesthesia combined with epidural block group （group GE）. Blood samples were collected before anesthesia （T0）, after targeted resection （T1）, after extubation （T2）, and 24 h after surgery （Ta） for the test of IL-6, IL-8, and IL-10. Perioperative complications as well as prognosis were recorded. Results： Compared with that at T0, serum IL-6, IL-8, and IL-10 concentrations of three groups gradually increased at T1-T3 （P〈0. 05）. Compared with that in group G, serum IL-6 concentrations were lower in both group GP and GE at T1 -T3 （P〈0. 05）, while serum IL8 concentrations were lower in group GE at T2-T3 （P〈0. 05）. The total incidence of perioperative complications in group G（60%） was higher than that in group GP（30%） and group GE（25%, P〈0. 05）. Conclusions： Compared with general anesthesia, general anesthesia combined with epidural block as well as general anesthesia combined with thoracic paravertebral block might partly inhibit the perioperative expression of serum inflammatory cytokines so as to reduce perioperative complications and improve prognosis.

关 键 词：椎旁神经阻滞 硬膜外阻滞 炎症因子 肺癌根治术 

分 类 号：R734.2[医药卫生—肿瘤]