文章摘要
丙泊酚对肺癌患者围术期肿瘤微转移的影响
Effect of propofol on the tumor micrometastasis of perioperative in patients with lung cancer
  
DOI：10.12089/jca.2020.03.010
中文关键词: 肺癌  丙泊酚  七氟醚  肿瘤微转移
英文关键词: Lung cancer  Propofol  Sevoflurane  Tumor micrometastasis
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作者单位E-mail
韩金玉 300060,天津医科大学肿瘤医院麻醉科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心  
赵洪伟 300060,天津医科大学肿瘤医院麻醉科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心 zlyymzk@126.com 
宋振国 300060,天津医科大学肿瘤医院麻醉科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心  
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中文摘要:
      
目的 探讨丙泊酚对肺癌根治术患者围手术期微转移是否存在影响,为临床麻醉精准化用药提供参考依据。方法择期行胸腔镜肺癌根治术患者40例,男21例,女19例,年龄30～65岁,BMI 20～30 kg/m2,ASA Ⅰ或Ⅱ级。随机分为丙泊酚静脉组(P组)和七氟醚吸入组(S组),每组20例。P组丙泊酚靶控浓度 3～4 μg/ml 维持麻醉。S组持续吸入1.5%～2%七氟醚维持麻醉。两组均静脉泵注瑞芬太尼0.4 ng/ml,手术开始后行单肺通气,手术全程维持BIS在40～60。分别于麻醉诱导前5 min(T0)、手术开始1 h(T1)、术毕即刻(T2)、术后24 h(T3),术后48 h(T4)监测 HR、SBP、DBP,记录T0—T2时BIS,并于T0—T4时点抽取中心静脉血5 ml,采用PCR技术检测细胞角蛋白19(CK19),肺特异性X蛋白(LUNX)阳性表达,记录CK19和LUNX阳性表达情况。
结果 与T0时比较,T1时P组HR明显减慢(P<0.05)。T1时P组HR明显慢于S组(P<0.05)。不同时点两组内组间SBP和DBP差异均无统计学意义。T0—T2时两组BIS组内组间比较差异均无统计学意义。T3—T4时P组CK19和LUNX阳性表达率明显低于S组(P<0.05)。T0—T2时两组CK19和LUNX阳性表达率差异无统计学意义。
结论 围术期应用丙泊酚有助于降低肿瘤微转移指标阳性表达,从而降低围术期肿瘤细胞进入循环系统形成微转移的风险,可以优先考虑用于肿瘤患者的围术期麻醉用药。
英文摘要:
      
Objective To investigate the effects of propofol on the perioperative micrometastasis in patients undergoing radical surgery for lung cancer,and to provide a reference for the precision medicine of clinical anesthesia.
Methods Forty patients undergoing thoracoscopic radical resection of lung cancer, 21 males and 19 females, aged 30-65 years, with a BMI 20-30 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: propofol intravenous group (group P, n = 20) and sevoflurane inhalation group (group S,n = 20). The target concentration of propofol in group P was 3-4 μg/ml to maintain anesthesia. The sevoflurane concentration of group S was 1.5%-2% to maintain anesthesia.Both groups were intravenously pumped with remifentanil 0.4 ng/ml. Single lung ventilation was performed after the start of the operation, and BIS was maintained at 40-60 throughout the operation. Hemodynamic parameters heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were monitored respectively 5 min before anesthesia induction (T0), 1 h after the operation (T1), at the end of the operation (T2), 24 h after the operation (T3), and 48 h after the operation (T4). BIS were recorded at T0-T2, and 5 ml of central venous blood was extracted at T0-T4. The expression of cytokeratin 19 (CK19) and lung specific X protein (LUNX) was detected by PCR, and the positive expression of CK19 and LUNX was recorded.
Results Compared with T0, the HR in group P was significantly slower at T1 (P < 0.05). The HR in group P at T1 was significantly slower than that in group S (P < 0.05). There was no significant difference in SBP and DBP between the two groups at different time points. There was no significant difference in BIS between the two groups at T0-T2. The positive expression rates of CK19 and LUNX in group P at T3-T4 were significantly lower than those in group S (P < 0.05). There was no significant difference in the positive expression rates of CK19 and LUNX between the two groups at T0-T2.
Conclusion The application of propofol during perioperative period can reduce the positive expression of tumor micrometastasis indicators, thus reducing the risk of tumor cells entering the circulatory system during perioperative period to form micrometastasis. Thus, intravenous anesthesia with propofol may be preferable to volatile anesthetics during cancer surgery.
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