国际麻醉学与复苏杂志   2019, Issue (2): 0-0
    
新辅助化疗对乳腺癌患者围手术期炎性因子及术后早期痛觉敏感性的影响
朱文超, 梁敏, 王金平, 刘伟, 李柯, 张宗旺1()
1.聊城市人民医院
Effect of neoadjuvant chemotherapy on inflammatory factors during perioperative period and early postoperative hyperalgesia in patients with breast cancer
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摘要:

目的 探讨新辅助化疗对行乳腺癌改良根治术的女性患者围手术期炎性因子及术后早期痛觉敏感性的影响。 方法 采用队列研究设计。择期行乳腺癌改良根治术的女性患者80例,ASA分级Ⅰ、Ⅱ级。根据是否接受新辅助化疗分为新辅助化疗组(N组)和对照组(C组),每组40例。所有患者均接受标准麻醉方案。记录患者一般情况、术中指标(手术时间、术中失血量及输液量、麻醉药物用量等)及术后指标(术后不良反应等)。于麻醉开始前即刻(T1)、气管插管后即刻(T2)、手术切皮后即刻(T3)、拔出气管导管后即刻(T4)及术后24 h(T5)分别采集外周静脉血3 ml,检测血清IL-1β、IL-6、IL-8、转化生长因子-β(transforming growth factor- β, TGF-β)的水平。采用疼痛数字评分法(Numerical Rating Scale, NRS)对患者T5、术后48 h(T6)、术后72 h(T7)进行疼痛评分。如患者术后NRS>4分,静脉给予奈福泮20 mg镇痛,30 min后再次评估。 结果 N组T5~T7时点NRS评分均高于C组,差异有统计学意义(P<0.05)。N组T1~T5各时间点IL-1β、IL-6、IL-8的浓度均高于C组,差异有统计学意义(P<0.05)。N组T1~T5各时间点TGF-β浓度均低于C组,差异有统计学意义(P<0.05)。 结论 新辅助化疗可增加乳腺癌改良根治术患者术后24~72 h的急性疼痛程度,可能与化疗药物使围手术期炎性因子IL-1β、IL-6、IL-8的表达增高、TGF-β的表达降低有关。

关键词: 新辅助化疗; 乳腺癌; 炎性因子; 疼痛; 痛觉过敏
Abstract:

Objective To investigate the effect of neoadjuvant chemotherapy on inflammatory factors and early postoperative hyperalgesia in patients undergoing modified radical mastectomy. Methods A cohort study was designed. Eighty female patients (20-60 years old) with American Society of Anesthesiologists (ASA) grades of Ⅰ, Ⅱ and body mass index 20-28 kg/m2, undergoing modified radical mastectomy were divided into neoadjuvant chemotherapy group (group N) or control group (group C) according to whether they received neoadjuvant chemotherapy. Each group has 40 cases. All patients took the standard anesthesia management. Patients′ general condition, intraoperative parameters (such as duration of operation, volume of intraoperative bleeding and blood transfusion, dosage of anesthetics, etc) and postoperative parameters (postoperative adverse effects) were recorded. We also collected 3 ml peripheral blood from patients at five time points [before the beginning of anesthesia (T1), after endotracheal intubation (T2), after skin incision (T3), after tube extraction (T4), 24 h after the operation (T5)] to detect the serum cytokines, such as interleukin (IL)-1β, IL-6, IL-8 and transforming growth factor- β (TGF-β). Pain intensity scores were recorded at point of 24 h after surgery (T5), 48 h after surgery (T6), 72 h after surgery (T7) by Numerical Rating Scale (NRS) score. If the NRS>4, intravenous nefopam 20 mg to analgesia, evaluated again 30 minutes later. Results The NRS scores of T5-T7 in group N were higher than scores in group C. The difference between the two groups was statistically significant (P<0.05). The concentrations of IL-1β, IL-6, IL-8 at each time point of T1-T5 in group N were higher than those concentrations of group C. The difference between the two groups was statistically significant (P<0.05). The concentration of TGF-β at each time point of T1-T5 in group N was lower than that of group C. The difference between the two groups was statistically significant (P<0.05). Conclusions Additional adjuvant chemotherapy can increase the pain extent the post-operative pain at 24-72 h after surgery in female patients with breast cancer. These increase of the acute pain can be attribute to the increased expression of IL-1β, IL6 and IL-8 perioperative cytokines and the down-regulation of the expression of TGF-β.

Key words: Neoadjuvant chemotherapy; Breast carcinoma; Inflammatory factor; Pain; Hyperalgesia