七氟醚与异氟醚用于肺癌根治术的麻醉效果及对血清基质金属蛋白酶、炎性因子、E-选择素及环氧合酶-2水平的影响

Efficacy of sevoflurane and isoflurane in radical operation for lung cancer and their effects on serum MMPS expression,inflammatory factors,E-selectin and COX-2 levels

目的探讨七氟醚与异氟醚用于肺癌根治术的效果及对血清基质金属蛋白酶(MMPs)表达、炎性因子、E-选择素(E-selectin)及环氧合酶-2(COX-2)水平的影响。方法2017年5月~2020年12月行三孔胸腔镜肺癌根治术治疗的肺癌病人86例,按照随机数字表法分为观察组(术中使用七氟醚维持麻醉)与对照组(术中使用异氟醚维持麻醉),每组各43例;对比两组术前(T_(0))、手术开始1小时(T_(1))、术毕(T_(2))、术后6小时(T_(3))等时点的基质金属蛋白酶(MMP)-2、MMP-9、E-selectin、COX-2、白细胞介素(IL)-4、IL-10、IL-6水平变化;评估苏醒时间、拔管时间、自主呼吸恢复、住院时间。结果在T_(1)、T_(2)、T_(3)时点,观察组的MMP-2分别为(328.11±23.15)ng/L、(335.41±23.85)ng/L、(342.52±25.52)ng/L,MMP-9分别为(357.01±24.02)ng/L、(365.85±25.69)ng/L、(375.01±27.01)ng/L,E-selectin分别为(59.11±6.02)ng/ml、(65.18±6.15)ng/ml、(57.25±5.69)ng/ml,COX-2分别为(21.15±2.11)ng/ml、(22.05±2.18)ng/ml、(22.35±2.02)ng/ml,IL-4分别为(14.11±2.65)ng/ml、(17.23±3.21)ng/ml、(22.01±3.96)ng/ml,IL-10(5.96±0.32)ng/ml、(7.25±0.58)ng/ml、(11.02±1.32)ng/ml,IL-6(44.12±3.41)ng/ml、(56.23±4.02)ng/ml、(57.14±4.09)ng/ml;对照组MMP-2分别(341.52±25.45)ng/L、(368.78±28.74)ng/L、(381.02±31.03)ng/L,MMP-9分别为(369.78±26.45)ng/L、(387.45±29.65)ng/L、(410.52±34.02)ng/L,E-selectin分别为(64.12±7.25)ng/ml、(72.36±8.45)ng/ml、(62.15±6.45)ng/ml,COX-2分别为(25.26±3.33)ng/ml、(25.35±3.28)ng/ml、(25.75±3.36)ng/ml,IL-4分别为(15.96±3.12)ng/ml、(22.69±4.52)ng/ml、(27.41±4.32)ng/ml,IL-10(7.12±0.55)ng/ml、(9.96±1.02)ng/ml、(15.21±1.96)ng/ml,IL-6(59.78±4.85)ng/ml、(77.65±5.32)ng/ml、(62.65±5.05)ng/ml;观察组T_(1)、T_(2)、T_(3)时点的MMP-2、MMP-9、E-selectin、COX-2、IL-4、IL-10、IL-6均低于对照组,差异有统计学意义(P<0.05)。观察组与对照组的苏醒时间分别为(20.21±2.32)分钟和(27.12±3.15)分钟,拔管时间分别为(24.23±2.85)分钟和(30.15±3.14)分钟,自主呼吸恢复分别为(10.25±1.23)分钟和(14.45±2.47)分钟,观察组均短于对照组,差异有统计学意义(P<0.05)。结论七氟醚与异氟醚相比,七氟醚用于肺癌根治术病人中麻醉效果更为理想,能在抑制炎性因子的同时,减轻应激反应对MMP-2、MMP-9、E-selectin、COX-2的影响。

Objective To investigate the effect of sevoflurane and isoflurane in radical resection of lung cancer and their effects on the expression of serum matrix metalloproteinases(MMPs),inflammatory factors,E-selectin(E-selectin)and cyclooxygenase-2(COX-2)level effect.Methods Lung cancer patients who underwent three-hole thoracoscopic radical resection for lung cancer from May 2017 to December 2020 were selected as the study objects,and were divided into observation group(intraoperative anesthesia maintained by sevoflurane)and control group(intraoperative anesthesia maintained by isoflurane)according to random number table,with 43 cases in each group.The level changes of matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),E-selectin,COX-2,interleukin-4(IL-4),interleukin-10(IL-10)and interleukin-6(IL-6)of the two groups were compared before surgery(T_(0)),1h after surgery(T_(1)),after surgery(T_(2)),and 6h after surgery(T_(3)).Recovery time,extubation time,recovery of spontaneous respiration,and length of hospital stay were evaluated.Results At T_(1),T_(2) and T_(3),the MMP-2 levels of the observation group were(328.11±23.15)ng/L,(335.41±23.85)ng/L,(342.52±25.52)ng/L,respectively.MMP-9 was(357.01±24.02)ng/L,(365.85±25.69)ng/L,(375.01±27.01)ng/L,respectively.E-selectin values were(59.11±6.02)ng/ml,(65.18±6.15)ng/ml,(57.25±5.69)ng/ml,respectively.COX-2 was(21.15±2.11)ng/ml,(22.05±2.18)ng/ml,(22.35±2.02)ng/ml,respectively.IL-4 was(14.11±2.65)ng/ml,(17.23±3.21)ng/ml,(22.01±3.96)ng/ml,respectively.IL-10 was(5.96±0.32)ng/ml,(7.25±0.58)ng/ml,(11.02±1.32)ng/ml,respectively.IL-6 was(44.12±3.41)ng/ml,(56.23±4.02)ng/ml,(57.14±4.09)ng/mlrespectively.In control group,MMP-2 was(341.52±25.45)ng/L,(368.78±28.74)ng/L,(381.02±31.03)ng/L,respectively.MMP-9 was(369.78±26.45)ng/L,(387.45±29.65)ng/L,(410.52±34.02)ng/L,respectively.E-selectin values were(64.12±7.25)ng/ml,(72.36±8.45)ng/ml,(62.15±6.45)ng/ml,respectively.COX-2 was(25.26±3.33)ng/ml,(25.35±3.28)ng/ml,(25.75±3.36)ng/ml,respectively.IL-4 was(15.96±3.12)ng/ml,(22.69±4.52)ng/ml,(27.41±4.32)ng/ml,respectively.IL-10 was(7.12±0.55)ng/ml,(9.96±1.02)ng/ml,(15.21±1.96)ng/ml,respectively.IL-6 was(59.78±4.85)ng/ml,(77.65±5.32)ng/ml,(62.65±5.05)ng/ml,respectively.The levels of MMP-2,MMP-9,E-selectin,COX-2,IL-4,IL-10 and IL-6 at T_(1),T_(2) and T_(3) in observation group were lower than those in control group(P<0.05).The recovery time of observation group and control group was(20.21±2.32)min and(27.12±3.15)min,respectively.The extubation time was(24.23±2.85)min and(30.15±3.14)min,and the recovery of spontaneous respiration was(10.25±1.23)min and(14.45±2.47)min,respectively.The observation group was shorter than the control group(P<0.05).Conclusion Compared with isoflurane,sevoflurane has a better anesthesia effect in patients undergoing radical resection of lung cancer.It can inhibit inflammatory factors and reduce the stress response to MMP-2,MMP-9,The influence of E-selectin and COX-2.