胸段硬膜外麻醉对肺癌手术患者炎性因子的影响  

Effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery

作　　者：盛晨 马俊杰[2] 李季 冯明静 宋杰[1] Sheng Chen;Ma Junjie;Li Ji;Feng Mingjing;Song Jie(Department of Anaesthesia,The Second People's Hospital of Liaocheng,The Second Hospital of Liaocheng Affiliated to Shandong First Medical University,Liaocheng 252600,Shandong Province,China;Department of Thoracic Surgery,The Second People's Hospital of Liaocheng,The Second Hospital of Liaocheng Affiliated to Shandong First Medical University,Liaocheng 252600,Shandong Province,China)

机构地区：[1]聊城市第二人民医院、山东第一医科大学附属聊城二院麻醉科,聊城252600 [2]聊城市第二人民医院、山东第一医科大学附属聊城二院胸外科,聊城252600

出　　处：《中国基层医药》2023年第7期1034-1039,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山东省聊城市第二人民医院科研项目(LCEYKY(202201-外-9))。

摘　　要：目的探讨胸段硬膜外麻醉(TEA)对肺癌手术患者炎性因子的影响。方法回顾性分析聊城市第二人民医院2020年6月至2022年5月行肺癌手术患者136例的临床资料,根据麻醉方式分为观察组89例、对照组47例,观察组采用TEA,对照组采用瑞芬太尼输注麻醉。比较两组从非依赖性肺收集的上皮衬液(ELF)中的肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10水平及血浆TNF-α、IL-6、丙二醛(MDA)水平、动脉氧分压/吸入氧分数(P/F)、并发症发生率、重做手术发生率、数字评级量表(NRS)评分、住院时间,评估不同麻醉方式对肺癌手术患者的影响。结果两组ELF中,单肺通气(OLV)终止后30 min(T2)TNF-α、IL-6、IL-10均显著高于OLV前(T1)(t=7.71、77.10、7.59、3.41、57.51、5.74,均P < 0.05);观察组T1、T2时TNF-α[(1.59±0.53)ng/L、(1.89±0.64)ng/L]、T1时IL-6[(2.96±0.82)ng/L]、IL-10[(1.99±0.53)ng/L]均显著高于对照组(t=10.45、2.59、2.00、7.19,均P < 0.05),T2时IL-6[(38.91±5.84)ng/L]显著低于对照组(t=33.25,P < 0.001),IL-10[(2.51±0.67)ng/L]在T2时高于对照组,但差异无统计学意义(P > 0.05)。两组血浆中,T1、T2时TNF-α差异均无统计学意义(均P > 0.05),T2时IL-6[(42.98±5.29)ng/L、(27.93±4.17)ng/L]均显著高于T1时(t=54.14、61.06,均P < 0.001);观察组T2时TNF-α[(1.60±0.56)ng/L]及T1、T2时IL-6[(0.92±0.16)、(27.93±4.17)ng/L]均显著低于对照组(t=3.39、6.96、18.20,均P < 0.05)。两组血浆MDA、P/F值、NRS评分、并发症发生情况、重做手术发生率及住院时间比较,差异均无统计学意义(均P > 0.05)。结论 TEA可以减轻肺癌患者手术期间肺局部炎性反应。Objective To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed.According to anesthesia methods,these patients were divided into an observation group(n=89)and a control group(n=47).The observation group was given thoracic segment epidural anesthesia,while the control group was given remifentanil infusion anesthesia.The tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and interleukin^(-1)0(IL-10)levels in the epithelial lining fluid collected from the non-dependent lung,the plasma levels of TNF-α,IL-6,and malondialdehyde,arterial partial pressure of oxygen/inhaled oxygen fraction,the incidence of complications,the incidence of re-operations,numeric rating scale score,and the length of hospital stay were compared between the two groups.The effects of different anesthesia methods on lung cancer surgery were evaluated.Results In each group,TNF-α,IL-6,and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation(T2)compared with those measured before one-lung ventilation(T1)(t=7.71,77.10,7.59,3.41,57.51,5.74,all P<0.05).In the observation group,TNF-α[(1.59±0.53)ng/L,(1.89±0.64)ng/L]measured at T1 and T2,IL-6[(2.96±0.82)ng/L]and IL-10[(1.99±0.53)ng/L]measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group(t=10.45,2.59,2.00,7.19,all P<0.05).In the observation group,IL-6 measured at T2[(38.91±5.84)ng/L]was significantly lower than that in the control group(t=33.25,P<0.001),and IL-10 measured at T2[(2.51±0.67)ng/L]was slightly,but not significantly higher than that in the control group(P>0.05).There was no significant difference in the plasma level of TNF-αmeasured at T1 and T2 between the two groups(both P>0.05).Plasma l

关 键 词：肺肿瘤 麻醉 硬膜外 肺切除术 炎症趋化因子类 肿瘤坏死因子α 白细胞介素6 白细胞介素10 丙二醛 

分 类 号：R614[医药卫生—麻醉学] R734.2[医药卫生—外科学]