丙泊酚对单肺通气下行食管癌根治术患者中性粒细胞核因子-κB与白介素-1及血流动力学的影响

Effects of propofol on neutrophil nuclear factor-κB,interleukin-1 and hemodynamic parameters in patients undergoing radical esophageal carcinoma resection with single-lung ventilation

目的探讨丙泊酚对单肺通气下行食管癌根治术患者中性粒细胞核因子-κB与白介素-1及血流动力学影响。方法选取接受食管癌根治术治疗的患者100例,采用随机数字表法分为研究组和对照组各50例。两组患者均注射瑞芬太尼,研究组患者静脉泵注丙泊酚,对照组患者静脉泵注生理盐水。采集患者插管后5 min(T1)、单肺通气时(T2)、单肺通气后30 min(T3)、单肺通气后60 min(T4)、单肺通气后90 min(T5)、恢复双肺通气时(T6)、恢复双肺通气后10 min(T7)与手术结束时(T8)8个时间点的桡动脉血,记录各时间点的平均动脉压(mean arterial pressure,MAP)及心率(hearth rate,HR),并使用凝胶电泳迁移率(electrophoretic mobility shift assay,EMSA)检测食管癌根治术患者中性粒细胞核因子-κB活性,采用酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)法检测白介素-1浓度。结果与对照组比较,研究组患者的MAP和HR在T1~T5时,差异均有统计学意义(均P<0.05);在T6、T7和T8时,差异均无统计学意义(均P>0.05)。研究组患者中性粒细胞核因子-κB结合活性和白介素-1浓度在各个时间点与对照组比较,差异均具有统计学意义(均P<0.05)。结论丙泊酚应用于单肺通气下行食管癌根治术患者中,可使中性粒细胞核因子-κB与白介素-1表达水平更低,血流动力学更稳定,安全性好。

Objective To investigate the effects of propofol on the level of neutrophil nuclear factor-κB and interleukin-1,and hemodynamics parameters in patients undergoing radical esophageal cancer resection with single pulmonary ventilation. Methods One-hundred patients undergoing radical resection of esophageal cancer were enrolled and randomly assigned into the study group and the control group with 50 cases each,by the random number table method. Remifentanil was injected into both groups. Propofol was intravenously pumped into the study group,whereas intravenous saline was administered to the control group. Radial artery blood samples were collected at five minutes after intubation（ T1）,one-lung ventilation（ T2）,30 min after one-lung ventilation（ T3）,60 min after one-lung ventilation（ T4）,90 min after one-lung ventilation（ T5）,and recovery of two-lung ventilation（ T6）,10 min after ventilation recovery（ T7） and the end-of-surgery（ T8）. The mean arterial pressure（ MAP） and heart rate（ HR） were also recorded at the above 8 time points. Electrophoretic mobility shift assay（ EMSA） was used to detect the activity of neutrophils nuclear factor-κB,and in enzyme-linked immunosorbent assay（ ELISA） was used to examine the concentration of interleukin-1 in the patients. Results Compared with the control group,the MAP and HR levels of the study group were significantly different at the 5 time points from T1 to T5（ all P〈0. 05）. However,no significant difference was detected between the two groups at T6,T7 and T8（ all P〉0. 05）. Moreover,the neutrophil nuclear factor-κB binding activity and the concentration of interleukin-1 were significantly different between the two groups at all time points analyzed in the study group（ all P〈0. 05）. Conclusion In patients undergoing radical esophageal cancer surgery with one-lung ventilation,the administration of propofol can significantly decrease the expression of NF-κB and interleukin-1 in neutrophils,along with more stable hemodynamics and increased safety.