七氟醚吸入麻醉和丙泊酚静脉麻醉对老年肺癌根治术患者血清VEGF、VCAM-1、MMP-2和MMP-9表达的影响

摘要

Objective To compare the effects of sevoflurane inhalational anesthesia and propofol intravenous anesthesia on the plasma levels of vascular endothelial growth factor ( VEGF ) , vascular cell adhesion molecule-1 ( VCAM-1 ) , matrix metalloproteinase-2 (MMP-2) and MMP-9 in the elderly patients undergoing radical surgery for lung cancer , and provide further reference for the options of clinical anesthesia .Methods Sixty ASAⅠorⅡlung cancer patients at the grade of American Society of Anesthesiologists ( ASA) ⅠorⅡand aged 60 to 75 years undergoing radical surgery for lung cancer in our hospital were recruited in this study , and randomly divided into 2 groups (n=30):sevoflurane group (group S) and propofol group (group P).After tracheal intubation, 1.7%-3.4%sevoflurane were given to the group S , and maintained its end-tidal of 1-2 MAC until the end of surgery , while, 1.5-3.0 μg /ml target effect-site concentration of propofol was given through controlled infusion in group P until the end .Venous blood samples of 2 ml were harvested at just before induction of anesthesia (T0), 1 h after surgery beginning (T1), 2 h after surgery beginning (T2), 1 h after the end of surgery (T3), and 2 h after the end of surgery (T4) for the levels of VEGF, VCAM-1, MMP-2 and MMP-9 by enzyme linked immunosorbent assay ( ELISA).Results Compared with T0, the plasma levels of VEGF and VCAM-1 were significantly decreased in group S at T1-T4 (P<0.05), and those of MMP-2 and MMP-9 were also reduced at T2-T4 (P<0.05).But no such differences were found in group P at T1-T4 (P>0.05).The levels of above indicators were obviously lower in group S than in group P at the period (P <0.05).Conclusion Compared with propofol intravenous anesthesia , sevoflurane inhalation can inhibit the expression of VEGF, VCAM-1, MMP-2 and MMP-9 in the elderly patients undergoing radical surgery for lung cancer .%目的：通过比较七氟醚吸入麻醉和丙泊酚静脉麻醉对老年肺癌根治术患者血清血管内皮生长因子（ VEGF）、血管细胞黏附分子－1（VCAM-1）、基质金属蛋白酶－2（MMP-2）和MMP-9表达的影响，进一步为临床麻醉选择提供参考。方法择期行肺癌根治术老年患者60例，年龄60～75岁，ASAⅠ～Ⅱ级，采用随机数字表法将60例患者分为七氟醚组（ S组）和丙泊酚组（P组），每组30例。 S组患者气管插管后持续吸入1．7％～3．4％的七氟醚至术毕，术中维持呼气末七氟醚浓度为1～2 MAC，P组患者气管插管后持续静脉输注丙泊酚至术毕，术中丙泊酚效应室浓度维持在1．5～3．0μg ／ml。分别于麻醉诱导前即刻（T0）、手术开始后1h（T1）、手术开始后2 h（T2）、手术结束后1 h（T3）、手术结束后2 h（T4）抽取静脉血2 ml，采用酶联免疫吸附法检测两组患者血清VEGF、VCAM-1、MMP-2和MMP-9表达。结果与T0时比较，S组T1～T4时血清VEGF及VCAM-1表达降低（P＜0．05），T2～T4时MMP-2和MMP-9表达降低（P＜0．05）；P组T1～T4时血清VEGF、VCAM-1、MMP-2和MMP-9表达无明显差异（P＞0．05）。与P组比较，S组T2～T4时血清VEGF、VCAM-1、MMP-2和MMP-9表达降低（P＜0．05）。结论与丙泊酚静脉麻醉相比七氟醚吸入麻醉能抑制老年肺癌根治术患者血清VEGF、VCAM-1、MMP-2和MMP-9的表达。