七氟醚预处理对肺癌胸腔镜手术中单肺通气氧化应激反应及炎性反应的影响
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摘要
目的探讨七氟醚预处理对肺癌胸腔镜手术中单肺通气(OLV)氧化应激反应及炎性反应的影响。方法对2012年12月—2016年12月四川省甘孜州人民医院收治的肺癌102例的临床资料进行回顾性分析,患者均经胸腔镜行肺叶切除术治疗,按麻醉方法分为对照组和观察组,每组51例。对照组在手术开始OLV前予以丙泊酚泵注,观察组在手术开始OLV前吸入2%七氟醚30 min。比较2组围术期不同时点氧化应激及炎性指标水平。结果两组T1~T3时点丙二醛(MDA)、炎性因子水平均较T0升高,且呈逐渐升高趋势,T2、T3时点超氧化物歧化酶(SOD)水平低于T0时点,且呈逐渐降低趋势(P<0.05)。观察组T3时点MDA、SOD水平和炎性因子水平均低于对照组(P<0.05)。观察组术后人血红素氧合酶水平高于对照组(P<0.05)。结论七氟醚预处理可明显抑制或减弱采用OLV经胸腔镜行肺叶切除肺癌患者的氧化应激和炎性反应,进一步降低肺部损伤,对肺组织起到一定保护作用。
Objective To investigate effects of Sevoflurane preconditioning on oxidative stress and inflammatory reaction of one-lung ventilation( OLV) in thorascopic surgery. Methods Clinical data of 102 patients with lung cancer admitted during December 2012 and December 2016 was retrospectively analyzed. All patients underwent pulmonary lobectomy under thoracoscopes,and the patients were divided into control group( n = 51) and observation group( n = 51)according to anaesthetic methods. Control group received Propofol pump injection before OLV,while observation group received 2% Sevoflurane inhalation for 30 min before OLV. Levels of oxidative stress and inflammatory indexes were compared at different times during surgery between two groups. Results Compared with those at T0,at T1-T3 in the two groups,levels of malondialdehyde( MDA) and inflammatory factors were significantly higher,and the levels were gradually increased; superoxide dismutase( SOD) levels at T2 and T3 were significantly lower,and the levels were gradually decreased( P < 0. 05). At T3,levels of MDA,SOD and inflammatory factors were significantly higher in observation group than those in control group( P < 0. 05). Postoperative heme oxygenase level in observation group was significantly higher than that in control group( P < 0. 05). Conclusion Sevoflurane preconditioning may significantly inhibit or decrease oxidative stress and inflammatory reaction in lung cancer patients with pulmonary lobectomy under one-lung ventilation thoracoscopy,further reduce lung injury and protect lung tissue in a certain degree.
Objective To investigate effects of Sevoflurane preconditioning on oxidative stress and inflammatory reaction of one-lung ventilation( OLV) in thorascopic surgery. Methods Clinical data of 102 patients with lung cancer admitted during December 2012 and December 2016 was retrospectively analyzed. All patients underwent pulmonary lobectomy under thoracoscopes,and the patients were divided into control group( n = 51) and observation group( n = 51)according to anaesthetic methods. Control group received Propofol pump injection before OLV,while observation group received 2% Sevoflurane inhalation for 30 min before OLV. Levels of oxidative stress and inflammatory indexes were compared at different times during surgery between two groups. Results Compared with those at T0,at T1-T3 in the two groups,levels of malondialdehyde( MDA) and inflammatory factors were significantly higher,and the levels were gradually increased; superoxide dismutase( SOD) levels at T2 and T3 were significantly lower,and the levels were gradually decreased( P < 0. 05). At T3,levels of MDA,SOD and inflammatory factors were significantly higher in observation group than those in control group( P < 0. 05). Postoperative heme oxygenase level in observation group was significantly higher than that in control group( P < 0. 05). Conclusion Sevoflurane preconditioning may significantly inhibit or decrease oxidative stress and inflammatory reaction in lung cancer patients with pulmonary lobectomy under one-lung ventilation thoracoscopy,further reduce lung injury and protect lung tissue in a certain degree.
引文
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[5]朱辉,侯丽娟,蔡强,等.七氟醚预处理对心肺转流下心脏瓣膜置换术患者外周血SOD、MDA及白细胞NF-κB的影响[J].江苏医药,2017,42(9):616-619.
[6]杨渝,邵志强,郭嘉祥,等.腹腔镜下行保留肾单位的肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响[J].国际泌尿系统杂志,2016,36(1):52-54.
[7]孙雪梅,王瑞婷,贺克强,等.七氟醚预处理对心脏瓣膜置换术患者血清c Tn I、外周血单核细胞Nrf2表达的影响[J].山东医药,2015,55(41):4-6.
[8]李辉,黄文峰,李明珠,等.单操作孔电视胸腔镜肺叶切除术治疗肺结核的临床疗效研究[J].解放军医药杂志,2016,28(6):58-61.
[9]蒋海斌,张铁峰,李颖,等.七氟醚与异丙酚麻醉对先心病患儿心肌氧化应激的影响[J].心脏杂志,2015,26(1):83-84.
[10]段晓雯,胡宪文,张启权,等.七氟醚后处理对脑缺血/再灌注损伤保护机制的研究进展[J].国际麻醉学与复苏杂志,2017,38(3):128-130.
[11]王洪萌,魏颖,林群,等.不同手术方式下老年高血压患者围术期心肌损伤和氧化应激的变化[J].中华高血压杂志,2016,24(10):974-977.
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[13]支修益,姚舒洋.肿瘤标志物在肺癌患者管理中的研究进展[J].首都医科大学学报,2015,36(6):986-991.
[14]张世锋.胸腔镜肺癌根治术对患者疼痛应激及代谢反应的影响观察[J].临床肺科杂志,2015,20(3):413-415.
[15]郑威,黄杰.胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响[J].实用癌症杂志,2017,32(2):295-298.
[16]魏合成,张海霞.全胸腔镜肺叶切除治疗肺癌的临床效果及对患者免疫功能、炎性因子和生存质量的影响[J].河北医药,2016,38(11):1688-1690.
[17]朱辉,李辉,杨进国,等.七氟醚预处理对CVR患者血清炎性细胞因子和心肌酶的影响[J].现代中西医结合杂志,2015,24(25):2743-2746.
[18]王友于,曾富春,丛伟,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者炎症因子及免疫功能的影响[J].现代生物医学进展,2015,15(18):3484-3486,3491.
[19]姜轶,杨帆,代文静.miR-539对肺癌细胞增殖和凋亡作用的研究[J].解放军医药杂志,2016,28(12):41-44.
[20]徐卫华,陈勇兵,蒋堪秋,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].中华老年医学杂志,2015,34(5):510-511.
[21]林称意.胸腔镜辅助肺叶切除术对早中期肺癌患者免疫功能及心肺功能的影响[J].实用心脑肺血管病杂志,2015,23(12):80-83.
[22]李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志,2017,22(7):1189-1192.
[23]陈丽丽,张建敏,郑铁华.Tosight喉镜用于新生儿气管插管时七氟醚吸入肺泡气浓度[J].首都医科大学学报,2015,36(3):469-472.
[24]于芸,张凯颖,韩如泉.七氟醚与丙泊酚用于成人开颅手术麻醉的比较:系统评价与Meta分析[J].首都医科大学学报,2013,34(5):733-741.
[25]李建华,赵广平,赵宏娟,等.乌司他丁联合肺保护性通气策略对胸腔镜下热灌注化疗肺癌患者的影响研究[J].实用心脑肺血管病杂志,2016,24(8):116-120.
[26]陈雄,王文,张静,等.非小细胞肺癌术后并发呼吸衰竭影响因素分析和静息肺功能检测临床价值[J].解放军医药杂志,2015,26(5):33-36.
[27]郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志,2016,19(3):122-128.
[2]屈亚云,武莉芳,张秀敏,等.依达拉奉对胸腔镜手术中单肺通气氧化应激反应及炎性反应的影响[J].临床麻醉学杂志,2016,32(2):148-150.
[3]周子瑜,李利平,刘瑶,等.不同吸入氧浓度对肺癌根治术患者单肺通气后氧合及氧化应激的影响[J].中国现代医学杂志,2016,26(13):79-84.
[4]苟亚军,陈聪,李燕,等.苦参素对胸腔镜术中单肺通气相关肺损伤的保护作用[J].局解手术学杂志,2016,25(4):276-279.
[5]朱辉,侯丽娟,蔡强,等.七氟醚预处理对心肺转流下心脏瓣膜置换术患者外周血SOD、MDA及白细胞NF-κB的影响[J].江苏医药,2017,42(9):616-619.
[6]杨渝,邵志强,郭嘉祥,等.腹腔镜下行保留肾单位的肾肿瘤切除术对患者氧化应激反应以及红细胞糖代谢的影响[J].国际泌尿系统杂志,2016,36(1):52-54.
[7]孙雪梅,王瑞婷,贺克强,等.七氟醚预处理对心脏瓣膜置换术患者血清c Tn I、外周血单核细胞Nrf2表达的影响[J].山东医药,2015,55(41):4-6.
[8]李辉,黄文峰,李明珠,等.单操作孔电视胸腔镜肺叶切除术治疗肺结核的临床疗效研究[J].解放军医药杂志,2016,28(6):58-61.
[9]蒋海斌,张铁峰,李颖,等.七氟醚与异丙酚麻醉对先心病患儿心肌氧化应激的影响[J].心脏杂志,2015,26(1):83-84.
[10]段晓雯,胡宪文,张启权,等.七氟醚后处理对脑缺血/再灌注损伤保护机制的研究进展[J].国际麻醉学与复苏杂志,2017,38(3):128-130.
[11]王洪萌,魏颖,林群,等.不同手术方式下老年高血压患者围术期心肌损伤和氧化应激的变化[J].中华高血压杂志,2016,24(10):974-977.
[12]Claroni C,Torregiani G,Covotta M,et al.Protective effect of sevoflurane preconditioning on ischemia-reperfusion injury in patients undergoing reconstructive plastic surgery with microsurgical flap,a randomized controlled trial[J].BMC Anesthesiol,2016,16(1):66.
[13]支修益,姚舒洋.肿瘤标志物在肺癌患者管理中的研究进展[J].首都医科大学学报,2015,36(6):986-991.
[14]张世锋.胸腔镜肺癌根治术对患者疼痛应激及代谢反应的影响观察[J].临床肺科杂志,2015,20(3):413-415.
[15]郑威,黄杰.胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响[J].实用癌症杂志,2017,32(2):295-298.
[16]魏合成,张海霞.全胸腔镜肺叶切除治疗肺癌的临床效果及对患者免疫功能、炎性因子和生存质量的影响[J].河北医药,2016,38(11):1688-1690.
[17]朱辉,李辉,杨进国,等.七氟醚预处理对CVR患者血清炎性细胞因子和心肌酶的影响[J].现代中西医结合杂志,2015,24(25):2743-2746.
[18]王友于,曾富春,丛伟,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者炎症因子及免疫功能的影响[J].现代生物医学进展,2015,15(18):3484-3486,3491.
[19]姜轶,杨帆,代文静.miR-539对肺癌细胞增殖和凋亡作用的研究[J].解放军医药杂志,2016,28(12):41-44.
[20]徐卫华,陈勇兵,蒋堪秋,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].中华老年医学杂志,2015,34(5):510-511.
[21]林称意.胸腔镜辅助肺叶切除术对早中期肺癌患者免疫功能及心肺功能的影响[J].实用心脑肺血管病杂志,2015,23(12):80-83.
[22]李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志,2017,22(7):1189-1192.
[23]陈丽丽,张建敏,郑铁华.Tosight喉镜用于新生儿气管插管时七氟醚吸入肺泡气浓度[J].首都医科大学学报,2015,36(3):469-472.
[24]于芸,张凯颖,韩如泉.七氟醚与丙泊酚用于成人开颅手术麻醉的比较:系统评价与Meta分析[J].首都医科大学学报,2013,34(5):733-741.
[25]李建华,赵广平,赵宏娟,等.乌司他丁联合肺保护性通气策略对胸腔镜下热灌注化疗肺癌患者的影响研究[J].实用心脑肺血管病杂志,2016,24(8):116-120.
[26]陈雄,王文,张静,等.非小细胞肺癌术后并发呼吸衰竭影响因素分析和静息肺功能检测临床价值[J].解放军医药杂志,2015,26(5):33-36.
[27]郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志,2016,19(3):122-128.