不同麻醉方法对白细胞介素-6和白细胞介素-10的影响

目的:本研究拟观察不同麻醉方法时对病人围术期促炎/抗炎性细胞因子及平衡的影响。方法:选择择期40例胆囊切除手术病人,ASA评分Ⅰ-Ⅱ级,随机分为2组:全凭静脉麻醉组(R组,n=20)和静吸复合麻醉组(F组,n=20)。R组以咪唑安定、异丙酚、维库溴铵和瑞芬太尼诱导气管插管,用微量泵以异丙酚和瑞芬太尼持续静脉输注维持麻醉,术中根据需要调节输注速度。F组麻醉诱导咪唑安定、异丙酚、芬太尼和维库溴铵诱导气管插管。术中静脉给予芬太尼及吸入异氟烷。手术结束时停止给药。两组均间断追加维库溴铵来维持肌松。在全麻诱导前,诱导后麻醉前,切皮后90 min,4 h,每次采血3 ml,采用酶联免疫吸附测量法(ELISA)测定细胞因子IL-6,IL-10。结果:两组病人的一般资料、麻醉期间MAP,HR,SpO2,呼出气PaCO2浓度及手术持续时间均无显著性差异(均为P>0.05)。在切皮后,4,12 h两组IL-6和IL-10浓度较麻醉前均有显著增加,两组组间比较有统计学差异。结论:控制术中炎症反应程度全凭静脉麻醉组优于静吸复合麻醉组,帮助减少手术的损伤,有利于患者的预后。

Effect of Different Anesthesia on Interleukin-6 and Interleukin-10 During Open Cholecystectomy

Objective: To study the effects of different anaesthetic techniques on the pro-and anti-inflammatory cytokines.Methods: Forty patients for open cholecystectomy in ASA Ⅰ-Ⅱ were involved in this study.Patients were randomly assigned to R group or F group with 20 cases in each group.In R group effects of total intravenous anesthesia(TIVA) with propofol and remifentanil were studied.In F group anesthesia was administered according to the anesthesiologist's usual practice using balanced inhalational anaesthesia with isoflurane.Blood samples were collected before induction of anaesthesia at 0,4 and 12 h after skin incision.IL-6 and IL-10 were measured using enzyme-linked immunosorbent assay(ELISA).Results: The level of IL-6 and IL-10 increased in patients at 4 h and 12 h in both groups after skin incision(all P<0.05).At 4 h and 12 h,IL-6 and IL-10 concentrations were significantly lower in group R compared with that of group F.Conclusion: TIVA using Propofol/remifentanil can suppress the inflammatory response caused by surgery and is superior to the balanced inhalational anaesthesia using isoflurane.