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| 肺保护性通气对腹腔镜结直肠癌手术患者血清CCL2和CCR2浓度及恢复质量的影响 |
| Effects of lung-protective ventilation on serum expression of CCL2 and CCR2 and recovery quality in patients undergoing laparoscopic colorectal cancer surgery |
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| DOI：10.12089/jca.2026.04.003 |
| 中文关键词: 肺保护性通气策略 CC类趋化因子2 CC类趋化因子受体2 恢复质量 |
| 英文关键词: Lung-protective ventilation strategy CC motifchemokine ligand 2 CC motifchemokine receptor 2 Quality of recovery |
| 基金项目:南通市卫健委资助项目（MS2023025） |
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| 中文摘要: |
目的： 观察肺保护性通气策略（LPVS）对腹腔镜结直肠癌（CRC）手术患者血清CC类趋化因子2（CCL2）及其受体2（CCR2）的浓度和术后恢复质量的影响。
方法： 选择择期全麻下行腹腔镜结直肠癌手术的患者，年龄50～74岁，BMI 18.5～30.0 kg/m2，ASA Ⅱ或Ⅲ级，预计加泰罗尼亚外科患者呼吸风险评估（ARISCAT）评分26～44分。采用随机数字表法将患者分为两组：传统通气策略组（C组）和肺保护性通气策略组（T组）。主要指标为拔除气管导管30 min后血清CCL2和CCR2浓度。次要指标包括麻醉诱导前、手术结束24 h时血清CCL2和CCR2浓度，术后3 d的术后恢复质量（QoR-15）评分，术后首次肛门排气时间和术后住院时间。不良反应包括术后7 d内肺部并发症。
结果： 共纳入患者58例，每组29例。与麻醉诱导前比较，两组拔除气管导管30 min、手术结束24 h血清CCL2浓度均明显升高（P<0.05）；与拔除气管导管30 min比较，C组手术结束24 h血清CCL2浓度明显降低（P<0.05）；与C组比较，T组拔除气管导管30 min血清CCL2浓度明显降低（P<0.05）。与麻醉诱导前比较，两组拔除气管导管30 min、手术结束24 h血清CCR2浓度均明显降低（P<0.05）；与C组比较，T组拔除气管导管30 min、手术结束24 h血清CCR2浓度均明显升高（P<0.05）。与C组比较，T组术后3 d的QoR-15评分均明显升高，术后7 d内肺部并发症发生率明显降低（P<0.05）。两组术后首次肛门排气时间、术后住院时间差异无统计学意义。
结论： LPVS可能通过抑制腹腔镜结直肠癌手术患者CCL2的过度表达，从而抑制CCR2与CCL2的结合，提高患者术后恢复质量。 |
| 英文摘要: |
Objective: To investigate the effects of lung-protective ventilation strategy (LPVS) on serum expression of CC chemokine ligand 2 (CCL2) and its receptor 2 (CCR2), as well as the quality of recovery in patients undergoing laparoscopic colorectal cancer (CRC) surgery.
Methods: Patients aged 50-74 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅱ or Ⅲ, and an expected assessing respiratory risk in surgical patients in Catalonia (ARISCAT) score of 26-44, who were scheduled for elective laparoscopic CRC surgery under general anesthesia, were enrolled. Patients were randomly divided into two groups using a random number table: conventional ventilation strategy group (group C) and lung-protective ventilation strategy group (group T). The primary outcomes included serum concentrations of CCL2 and CCR2 at 30 minutes after tracheal extubation. Secondary outcomes included serum concentrations of CCL2 and CCR2 at baseline before anesthesia induction and 24 hours after surgery, the 15-item Quality of Recovery (QoR-15) score on 3 days postoperatively, time to first flatus after surgery and postoperative hospital stay. Adverse events included pulmonary complications within 7 days after surgery.
Results: A total of 58 patients were included, 29 patients in each group. Compared with baseline, serum CCL2 concentration was significantly increased at 30 minutes after extubation and 24 hours after surgery in both groups (P < 0.05). Compared with 30 minutes after extubation, serum CCL2 concentration was significantly decreased at 24 hours after surgery in group C (P < 0.05). Compared with group C, serum CCL2 concentration at 30 minutes after extubation was significantly lower in group T (P < 0.05). Compared with baseline, serum CCR2 concentration was significantly decreased at 30 minutes after extubation and 24 hours after surgery in both groups (P < 0.05). Compared with group C, serum CCR2 concentrations at 30 minutes after extubation and 24 hours after surgery were significantly higher in group T (P < 0.05). Compared with group C, the QoR-15 score was significantly higher in group T 3 days postoperatively, and the incidence of pulmonary complications within 7 days after surgery was significantly lower (P < 0.05). There was no statistically significant difference in time to first flatus and postoperative hospital stay between the two groups.
Conclusion: LPVS may improve the quality of postoperative recovery in patients undergoing CRC surgery by inhibiting the overexpression of CCL2 and thereby reducing the binding of CCL2 to CCR2. |
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