脾脏交感神经阻滞对α7nAChR依赖胆碱能抗炎通路的影响  

Effects of Splenic Sympathetic Nerve Blockade on theα7nAChR-Dependent Cholinergic Anti-Inflammatory Pathway

作　　者：方兴君 张锐娇 袁培华 邬仕寅 曲良超[2,3] FANG Xing-jun;ZHANG Rui-jiao;YUAN Pei-hua;WU Shi-yin;QU Liang-chao(Medical Department of Graduate School,Nanchang University,Nanchang 330006,China;Center for Anesthesiology and Pain Medicine of the First Affiliated Hospital,Nanchang University,Nanchang 330006,China;Anesthesia Department of Ganjiang New Area Hospital of the First Affiliated Hospital,Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学研究生院医学部,南昌330006 [2]南昌大学第一附属医院麻醉与疼痛医学中心,南昌330006 [3]南昌大学第一附属医院赣江新区医院麻醉手术部,南昌330006

出　　处：《南昌大学学报（医学版）》2024年第4期59-64,共6页Journal of Nanchang University：Medical Sciences

基　　金：江西省卫健委科技计划项目(202210380)。

摘　　要：目的观察脾脏交感神经阻滞对α7烟碱型乙酰胆碱受体(α7 nicotinic acetylcholine receptor,α7n AChR)依赖胆碱能抗炎通路的影响。方法使选取60例择期行胸腔镜肺部手术患者,按手术部位实施同侧交感神经阻滞。观察组30例行左侧T7椎旁神经阻滞,阻滞脾脏交感神经;对照组30例行右侧T7椎旁神经阻滞,阻滞同平面交感神经。采用超声多普勒检测2组阻滞前后脾动脉阻力指数(RI),采用ELISA法检测2组术前(T1)、手术开始后30 min(T2)、手术结束时(T3)、术后12 h(T4)、术后24 h(T5)血清α7nAChR水平及炎症因子[白介素-1β(IL-1β)、白介素-6(IL-6)和肿瘤坏死因子α(TNF-α)]表达水平。结果脾脏多普勒超声显示,与阻滞前相比,观察组脾动脉RI值显著降低(P<0.05)。与T1时点比较,观察组血清α7nAChR水平在T5时点明显升高(P<0.05),2组T4、T5时点血清IL-1β、IL-6、TNF-α水平均明显升高(P<0.05);观察组T4、T5时点血清α7nAChR水平显著高于对照组(P<0.05),血清IL-1β、IL-6、TNF-a水平显著低于对照组(P<0.05)。结论脾脏交感神经阻滞可以激活α7nAChR依赖的胆碱能抗炎通路,从而减轻肺叶切除术患者术后炎症反应。Objective To investigate the effects of splenic sympathetic nerve blockade on theα7nAChR-dependent cholinergic anti-inflammatory pathway in patients undergoing lobectomy.Methods 60 patients undergoing elective thoracoscopic lung surgery were selected and ipsilateral sympathetic nerve blocks were performed according to the surgical site.In the experimental group,30 left T7 paravertebral nerve blocks were performed to block the splanchnic sympathetic nerves;in the control group,30 right T7 paravertebral nerve blocks were performed to block the sympathetic nerves in the same plane.Ultrasound Doppler was used to detect the splenic artery resistance index(RI)before and after blockade in the 2 groups.The serumα7nAChR levels and the expression levels of inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factorα(TNF-α)]were detected by ELISA at preoperative(T1),30 min after the beginning of the surgery(T2),at the end of the surgery(T3),at 12 h after the surgery(T4),and at 24 h after the surgery(T5)in the 2 groups.Results Splenic Doppler ultrasound showed that the RI of the splenic artery was significantly lower in the experimental group compared with that before blockade(P<0.05).Compared with the T1 time point,the serumα7nAChR level was significantly higher at the T5 time point in the experimental group(P<0.05),and the serum IL-1β,IL-6,and TNF-αlevels were significantly higher at the T4 and T5 time points in both groups(P<0.05);the serumα7nAChR level in the experimental group was significantly higher than that in the control group at the T4 and T5 time points(P<0.05),and the serum IL-1β,IL-6,and TNF-αlevels were significantly lower than those of the control group(P<0.05).Conclusions Splenic sympathetic nervous system block can activate theα7nAChR-dependent cholinergic anti-inflammatory pathway and reduce postoperative inflammatory response in patients undergoing pulmonary lobectomy.

关 键 词：交感神经阻滞 肺叶切除术 Α7烟碱型乙酰胆碱受体 胆碱能抗炎通路 炎症反应 

分 类 号：R614.4[医药卫生—麻醉学]