超声引导胸椎旁神经阻滞在妇科手术中的应用价值及其对机体Nrf2-Keap1-ARE信号通路相关因子的影响

Value of ultrasound-guided thoracic paravertebral block in gynecological surgery and its effect on Nrf2-Keap1-ARE signaling pathway-related factors in the organism

目的分析超声引导胸椎旁神经阻滞在妇科手术中的应用价值及其对核因子E2相关因子2(Nrf2)-Kelch样环氧氯丙烷相关蛋白-1(Keap1)-抗氧化反应元件(ARE)信号通路相关因子的影响。方法选取2021年1-12月广州市番禺区妇幼保健院妇科手术患者100例作为研究对象,以随机数表法分为两组,对照组50例患者行气管插管全身麻醉,观察组50例患者行气管插管全身麻醉复合超声引导下胸椎旁神经阻滞。比较两组患者术中丙泊酚、舒芬太尼用量,手术时间,围手术期平均动脉压(MAP)、心率(HR),术后12、24、48 h疼痛程度以及血清Nrf2、Keap1、ARE、丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平。结果观察组术中丙泊酚、舒芬太尼用量明显低于对照组,差异有统计学意义(P<0.05)。观察组患者T1~T4时刻MAP、HR均明显低于对照组,差异有统计学意义(P<0.05)。观察组患者术后12、24、48 h的视觉模拟评分(VAS)评分低于对照组,外周血Nrf2、Keap1、ARE蛋白水平均明显高于对照组,差异有统计学意义(P<0.05)。观察组患者术后12、24、48 h血清SOD、CAT水平均明显高于对照组,MDA水平明显低于对照组,差异有统计学意义(P<0.05)。结论超声引导胸椎旁神经阻滞可改善Nrf2-Keap1-ARE信号通路,减轻妇科手术患者氧化应激反应,缓解术后疼痛,并稳定围手术期血流波动,值得临床重视。

Objective To analyze the application value of ultrasound-guided thoracic paravertebral block in gynecological surgery and its effect on nuclear factor E2-related factor 2(Nrf2)-Kelch-like epichlorohydrinassociated protein-1(Keap1)-antioxidant response element(ARE)signaling pathway-related factors.Methods A total of 100 patients undergoing gynecological surgery in Panyu Maternity and Child Health Care Hospital in Guangzhou from January to December 2021 were selected as study subjects,and they were divided into two groups by the random number table method.50 patients in the control group underwent general anesthesia with tracheal intubation,while another 50 patients in the observation group underwent general anesthesia with tracheal intubation combined with ultrasound-guided thoracic paravertebral block.The intraoperative propofol and sufentanil dosage,operation time,perioperative mean arterial pressure(MAP)and heart rate(HR),pain level,serum Nrf2,Keap1,ARE,malondialdehyde(MDA),superoxide dismutase(SOD)and catalase(CAT)levels at 12 h,24 h and 48 h postoperatively were compared between the two groups.Results The intraoperative propofol and sufentanil dosages in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The MAP and HR of patients in the observation group at T1-T4 were significantly lower than those in the control group,with statistically significant differences (P < 0.05). The visual analog scale (VAS) scores in the observation group at 12 h, 24 h, 48 h postoperatwely were lower than those in the control group, and peripheral blood Nrf2, Keap1, ARE protein levels of patients in the observation group at 12 h, 24 h, and 48 h postoperatively were significantly higher than those in the control group, with statistically significant differences (P < 0.05). The SOD and CAT levels were significantly higher while the serum MDA levels were significantly lower in the observation group than those in the control group at 12 h, 24 h, and 48 h postoperatively, with statistically significant differences (P < 0.05). Conclusion Ultrasound-guided thoracic paravertebral block can improve the Nrf2-Keap1-ARE signaling pathway, as well as reduce oxidative stress, relieve postoperative pain, and stabilize perioperative blood flow in patients undergoing gynecological surgery, which deserves clinical attention.