静脉注射利多卡因对非小细胞肺癌电视辅助胸腔镜手术后血清白细胞介素-17 的影响：一项随机、双盲、安慰剂对照试验。
Effect of Intravenous Lidocaine on Serum Interleukin-17 After Video-Assisted Thoracic Surgery for Non-Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial.
机构信息
Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Department of Anesthesiology, Taicang First People's Hospital, Taicang Affiliated Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China.
出版信息
Drug Des Devel Ther. 2021 Aug 3;15:3379-3390. doi: 10.2147/DDDT.S316804. eCollection 2021.
PURPOSE
Surgical stress promotes tumor metastasis. Interleukin (IL)-17 plays a pivotal role in cancer progression, and high IL-17 expression predicts poor prognosis of non-small-cell lung cancer (NSCLC). Lidocaine may exert tumor-inhibiting effects. We hypothesize that intravenous lidocaine attenuates surgical stress and reduces serum IL-17 levels during video-assisted thoracic surgery (VATS) for NSCLC.
METHODS
This randomized, double-blind, placebo-controlled trial included 60 early-stage NSCLC patients undergoing VATS, into a lidocaine group (n = 30; intravenous lidocaine bolus 1.0 mg/kg, and 1.0 mg/kg/h until the end of surgery) or a normal saline control group (n = 30). The primary outcome was serum IL-17 level at 24 hours postoperatively. The secondary outcomes included serum IL-17 level at the time of post-anesthesia care unit (PACU) discharge, serum cortisol level at PACU discharge and postoperative 24 hours, pain scores (0-10) from PACU discharge to 48 hours postoperatively, incidences of postoperative nausea and vomiting, dizziness, and arrhythmia during 0-48 hours postoperatively, and 30-day mortality. Long-term outcomes included chemotherapy, cancer recurrence, and mortality.
RESULTS
The lidocaine group had lower serum IL-17 at 24 hours postoperatively compared with the control group (23.0 ± 5.8 pg/mL vs 27.3 ± 8.2 pg/mL, difference [95% CI] = -4.3 [-8.4 to -0.2] pg/mL; = 0.038). The lidocaine group also had reduced serum IL-17 (difference [95% CI] = -4.6 [-8.7 to -0.5] pg/mL), serum cortisol (difference [95% CI] = -37 [-73 to -2] ng/mL), and pain scores (difference [95% CI] = -0.7 [-1.3 to -0.1] points) at PACU discharge. During a median follow-up of 10 (IQR, 9-13) months, 2 patients in the lidocaine group and 6 patients in the control group received chemotherapy, one patient in the control group had cancer recurrence, and no death event occurred.
CONCLUSION
Intravenous lidocaine was associated with reduced serum IL-17 and cortisol following VATS procedures in early-stage NSCLC patients.
TRIAL REGISTRATION
ChiCTR2000030629.
目的
手术应激促进肿瘤转移。白细胞介素（IL）-17 在癌症进展中起关键作用，高 IL-17 表达预示非小细胞肺癌（NSCLC）的预后不良。利多卡因可能具有抑制肿瘤的作用。我们假设静脉内利多卡因可减轻 NSCLC 电视辅助胸腔镜手术（VATS）期间的手术应激并降低血清 IL-17 水平。
方法
这项随机、双盲、安慰剂对照试验纳入了 60 例接受 VATS 的早期 NSCLC 患者，分为利多卡因组（n = 30；静脉推注利多卡因 1.0 mg/kg，然后以 1.0 mg/kg/h 的速度持续至手术结束）或生理盐水对照组（n = 30）。主要结局为术后 24 小时的血清 IL-17 水平。次要结局包括麻醉后护理单元（PACU）出院时的血清 IL-17 水平、PACU 出院和术后 24 小时的血清皮质醇水平、PACU 出院至术后 48 小时的疼痛评分（0-10）、术后 0-48 小时恶心和呕吐、头晕和心律失常的发生率以及 30 天死亡率。长期结局包括化疗、癌症复发和死亡率。
结果
与对照组相比，利多卡因组术后 24 小时的血清 IL-17 水平更低（23.0 ± 5.8 pg/mL 比 27.3 ± 8.2 pg/mL，差异 [95%CI] = -4.3 [-8.4 至 -0.2] pg/mL； = 0.038）。利多卡因组的血清 IL-17（差异 [95%CI] = -4.6 [-8.7 至 -0.5] pg/mL）、皮质醇（差异 [95%CI] = -37 [-73 至 -2] ng/mL）和 PACU 出院时的疼痛评分（差异 [95%CI] = -0.7 [-1.3 至 -0.1] 分）也更低。在中位数为 10（IQR，9-13）个月的中位随访期间，利多卡因组有 2 例患者和对照组有 6 例患者接受了化疗，对照组有 1 例患者发生癌症复发，无死亡事件发生。
结论
静脉内利多卡因与早期 NSCLC 患者 VATS 手术后的血清 IL-17 和皮质醇降低有关。
试验注册
ChiCTR2000030629。
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