利多卡因对宫颈癌根治术患者应激激素及NK细胞杀伤力的影响

发布时间：2018-04-02 10:13

本文选题：利多卡因　切入点：宫颈癌根治术　出处：《临床麻醉学杂志》2017年11期

【摘要】：目的观察围术期静脉输注利多卡因对宫颈癌根治术患者应激激素和自然杀伤(NK)细胞杀伤力的影响,探讨利多卡因围术期免疫保护作用。方法择期拟行宫颈癌根治术患者35例,年龄35~65岁,ASAⅠ或Ⅱ级,采用随机数字表法分为利多卡因组(L组)和对照组(C组)。麻醉诱导前15min,L组患者静注利多卡因1.5mg/kg,随后利多卡因1.5mg·kg~(-1)·h~(-1)持续泵注至患者出室;C组患者给予等量生理盐水。分别于术前24h、术毕即刻、术后48h采集患者外周静脉血,ELISA法测定血浆PGE2、EPI、NE浓度。免疫磁珠法分离NK细胞,乳酸脱氢酶释放法检测NK细胞杀伤力,Western blot法检测NK细胞磷酸化蛋白激酶A(p-PKA)和蛋白激酶A(PKA)表达。结果术前24h两组患者血浆PGE2、EP1和NE浓度差异无统计学意义。术后48h,L组血浆PGE2浓度[(562.5±98.2)pg/ml vs(663.2±119.0)pg/ml]、EPI浓度[(24.9±4.8)pg/ml vs(29.7±3.5)pg/ml]、NE浓度[(408.3±47.2)pg/ml vs(499.6±45.6)pg/ml]明显低于C组(P0.05)。术后48h,L组NK细胞杀伤力明显高于C组[(44.1±5.0)%vs(37.1±5.5)%,P0.05]。术毕即刻,L组p-PKA/PKA明显低于C组(0.060±0.008vs 0.099±0.011)(P0.05)。结论围术期静脉输注利多卡因能降低宫颈癌根治术患者血浆PGE2及儿茶酚胺水平;保护NK细胞对肿瘤细胞的杀伤能力,其机制可能是通过抑制cAMP-PKA信号通路。
[Abstract]:Objective to observe the effect of perioperative intravenous infusion of lidocaine on the cytotoxicity of stress hormone and natural killer NKK cells in patients with cervical cancer after radical resection, and to explore the protective effect of lidocaine on perioperative immunity. Aged 35 to 65 years with ASA I or II, The patients in the L group were given Lidocaine 1.5 mg / kg 15 min before anesthesia induction, and then Lidocaine 1.5mg kg-1) HX -1) was continuously pumped to the patients in group C to receive the same amount of normal saline. 24 hours before operation, immediately after surgery, Peripheral venous blood samples were collected 48 hours after operation to determine plasma PGE2EPINE concentration. NK cells were isolated by immunomagnetic beads. Lactate dehydrogenase release assay was used to detect the cytotoxicity of NK cells. Western blot assay was used to detect the expression of phosphorylated protein kinase (PP-PKA) and protein kinase (PKA) in NK cells. Results there was no significant difference in plasma PGE2EP1 and NE levels between the two groups 24 hours before operation. The concentration of plasma PGE2 [562.5 卤98.2)pg/ml vs(663.2 卤119.0)pg/ml] PGE2 [24.9 卤4.8)pg/ml vs(29.7 卤3.5)pg/ml] NE [408.3 卤47.2)pg/ml vs(499.6 卤45.6)pg/ml] was significantly lower than that of C group (P 0.05). The cytotoxicity of NK cells in group L was significantly higher than that in group C [44.1 卤5.0)%vs(37.1 卤5.5 P0.05]. Immediately after operation, p-PKA/PKA in group L was significantly lower than that in group C (0.060 卤0.008vs 0.099 卤0.011). Conclusion intravenous infusion of lidocaine in perioperative period can decrease the cytotoxicity of NK cells. Plasma PGE2 and catecholamine levels in patients with cervical cancer undergoing radical resection; The mechanism of protecting NK cells against tumor cells may be by inhibiting cAMP-PKA signaling pathway.
【作者单位】：山东中医药大学附属医院麻醉科;山东大学齐鲁医院麻醉科;山东大学深圳研究院;
【基金】：国家自然科学基金(81570044) 山东省自然科学基金(ZR2015HM038) 深圳市未来产业专项资金(JCYJ20150402105524051)
【分类号】：R614;R737.33

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