RIPC对新辅助化疗后乳腺癌手术患者早期预后的影响OA
Effects of Remote Ischemic Preconditioning on Early Prognosis in Breast Cancer Patients undergoing Breast Cancer Surgery after Neoadjuvant Chemotherapy
目的:评价远端肢体缺血预处理(RIPC)对新辅助化疗后乳腺癌手术患者早期预后的影响.方法:选取2022年6 月—2023 年 7 月郑州大学附属洛阳中心医院新辅助化疗后拟行手术治疗的 42 例乳腺癌患者作为研究对象,随机分为对照组和RIPC组,各 21 例.两组采用相同麻醉方法进行乳腺癌手术,其中RIPC组在麻醉诱导后手术前行RIPC处理,对照组不做处理.比较两组手术指标及术后恢复情况;比较两组麻醉前(T1)、手术开始(T2)、手术结束(T3)、术后 1 d(T4)时肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-12(IL-12)及 8-异前列腺素F2α(8-iso-PGF2α)及调节性T细胞(Treg细胞);比较两组T1、T2、T3 时的平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)及术中血管活性药物用量;比较两组术后 1 d、7 d的 15 项恢复质量(QoR-15)评分.结果:RIPC组术后排气时间、下床时间早于对照组,患者满意度高于对照组,差异有统计学意义(P<0.05).两组去甲肾上腺素用量比较,差异无统计学意义(P>0.05).T2、T3、T4 时,两组TNF-α、IL-10、IL-12、8-iso-PGF2α及外周血Treg细胞均高于T1 时,差异有统计学意义(P<0.05);T2 时,RIPC组TNF-α、IL-12、8-iso-PGF2α及外周血Treg细胞均高于对照组,差异有统计学意义(P<0.05);T3、T4时,RIPC组TNF-α、IL-12、8-iso-PGF2α及外周血Treg细胞均低于对照组,而IL-10 高于对照组,差异有统计学意义(P<0.05).术后 1 d、7 d,RIPC组QOR-15 评分均明显高于对照组,差异有统计学意义(P<0.05).结论:RIPC可减轻新辅助化疗后乳腺癌手术患者机体过氧化应激反应,抑制炎症反应,改善免疫功能,有利于患者早期康复.
Objective:To evaluate the effect of remote ischemic preconditioning(RIPC)on the early prognosis of breast cancer patients undergoing breast cancer surgery after neoadjuvant chemotherapy.Method:A total of 42 patients with breast cancer who planned to undergo surgery after neoadjuvant chemotherapy in Luoyang Central Hospital Affiliated to Zhengzhou University from June 2022 to July 2023 were selected as the study objects and randomly divided into control group and RIPC group,with 21 patients in each group.The two groups were treated with the same anesthesia method for breast cancer surgery.The RIPC group was treated with RIPC before surgery after anesthesia induction,while the control group was treated without RIPC.The operative indexes and postoperative recovery of the two groups were compared.The tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),interleukin-12(IL-12),8-isoprostaglandin F2α(8-iso-PGF2α)and regulatory T cells(Treg cells)before anesthesia(T1),at the beginning of surgery(T2),at the end of surgery(T3)and after surgery1 d(T4)between the two groups were compared.The mean arterial pressure(MAP),heart rate(HR),bifrequency index(BIS)at T1,T2 and T3 and the amount of vasoactive drugs between the two groups were compared.The quality of recovery-15 score(QOR-15)scores of the two groups at 1 d and 7 d after surgery were compared.Result:Postoperative exhaust time and getting out of bed time in RIPC group were earlier than those in control group,and patient satisfaction was higher than that in control group,the differences were statistically significant(P<0.05).There was no significant difference in the dosage of Norepinephrine between the two groups(P>0.05).At T2,T3 and T4,TNF-α,IL-10,IL-12,8-iso-PGF2α and peripheral blood Treg cells in both groups were higher than those at T1,and the differences were statistically significant(P<0.05).At T2,TNF-α,IL-12,8-iso-PGF2α and peripheral blood Treg cells in RIPC group were higher than those in control group,the differences were statistically significant(P<0.05).At T3 and T4,TNF-α,IL-12,8-iso-PGF2α and peripheral blood Treg cells in RIPC group were lower than those in control group,while IL-10 was higher than that in control group,the differences were statistically significant(P<0.05).The QOR-15 score of RIPC group were significantly higher than those of control group at 1 d and 7 d after surgery,the differences were statistically significant(P<0.05).Conclusion:RIPC can reduce the peroxidation stress reaction,inhibit inflammation and improve immune function in patients undergoing breast cancer surgery after neoadjuvant chemotherapy,which is conducive to early recovery of patients.
周彪;崔鹏;胡杰;彭靓;李振宇;韩国瑞
郑州大学附属洛阳中心医院 河南 洛阳 471003
远隔缺血预处理新辅助化疗乳腺癌
Remote ischemic preconditioningNeoadjuvant chemotherapyBreast cancer
《中外医学研究》 2024 (008)
137-142 / 6
河南省医学科技攻关计划联合共建项目(LHGJ20220956)
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