悬吊式、气腹腹腔镜及不同麻醉方法对妇科患者细胞因子水平的影响

目的 比较在不同麻醉方法下妇科悬吊式或气腹腹腔镜患者术中血清细胞因子白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)和热休克蛋白70(heat shock protein 70,HSP70)水平的变化.方法 选择57例择期行腹腔镜下子宫肌瘤剔除术的患者,手术时间均短于100 min,按手术方式或患者的意愿分成3组(每组19例):Ⅰ组,于静脉全麻下行CO2气体腹腔镜手术；Ⅱ组,于静脉全麻下行悬吊式腹腔镜手术；Ⅲ组,于硬膜外神经阻滞麻醉下行悬吊式腹腔镜手术.监测3组患者麻醉前(T1)、气腹或悬吊建立后30 min(T2)、气腹或悬吊撤除后10 min(T3)和术后第2天晨8时(T4)4个时点的TNF-α、IL-6、IL-10和HSP70浓度.结果 麻醉前患者的血清IL-6、IL-10、TNF-α和HSP70水平差异均无统计学意义(P＞0.05).术后各指标的水平均升高,其中Ⅰ组在T3时达峰值,Ⅱ组和Ⅲ组在T4时达峰值.组间比较,Ⅰ组在T2时点的TNF-α水平[(31±14) pg/L)]高于Ⅱ组[(24±10) pg/L] (P＜0.05)；在T3时点,Ⅰ组的IL-6[ (46±8) pg/L]、TNF-α[( 54±18) pg/L]和HSP70[ (3.18±0.58) μg/L]水平分别显著高于Ⅱ组[( 39±6) pg/L,(36±17) pg/L,(2.30±0.29) μg/L](P＜0.叭),且IL-6/IL-10比值也高于Ⅱ组(P＜0.05)；此时,Ⅲ组的IL-6[(27±10) pg/L]和TNF-α[(24±7)pg/L]水平低于Ⅱ组(P＜0.05).结论 悬吊式腹腔镜技术免除了CO2气腹对机体的影响,降低了术中应激反应水平,与全身麻醉相比,硬膜外麻醉可进一步减轻此术式引起的应激反应.

The effects of abdominal wall-lifting technique, pneumoperitoneum and different anesthesia methods on serum cytokines levels in gynecological patients underwent laparoscopic operation

Objective To study the variation of serum interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor alpha(TNF-α) and heat shock protein 70(HSP70) in patients underwent gynecological laparoscopic operations using abdominal walllifting(a gasless technique) or pneumoperitoneum methods under different anesthesia.Methods Fifty-seven patients scheduled for gynecological laparoscopy,with operation time less than 100 min,were randomly divided into three groups ( Ⅰ,Ⅱ,Ⅲ ) with 19cases in each group respectively.Group Ⅰ patients were operated with CO2 pneuioperitoneum laparoscopy under general anesthesia.Group Ⅱ patients were operated under general anesthesia and abdominal wall-lifting technique.Group Ⅲ patients went through the same operative procedures as group Ⅱ,but under epidural anesthesia.Serum levels of IL-6,IL-10,TNF-α and HSP70 of all patients were monitored at four points:before anesthesia (Tt),30 min after the establishment of pneumoperitoneum or wall-lifting (T2),10min after it's removal (T3),and at 8 am on the following day (T4).Results There were no significant difference among serum levels of IL-6,IL-10,TNF-α and HSP70 of the three groups at T1(P＞0.05).The serum levels of all these indexes increased after the beginning of the operations,and reaching its peak at T3 in group Ⅰ and peak values at T4 in group Ⅱ and Ⅲ.The level of serum T NF-α[(31±I4) pg/L] was higher in group Ⅰ than that in group Ⅱ [(24±10) pg/L] at T2(P＜0.05).At point T3,serum levels of IL-6[(46±8)pg/L],TNF-α[(54±18) pg/L and HSP70[(3.18±0.58) μg/L] were significantly higher in group Ⅰ than those[ (39±6) pg/L,(36±17) pg/L,(2.30±0.29) μg/L] in group Ⅱ (P＜0.01),and so was the ratio of IL-6/IL-10(P＜0.05 ).Meanwhile,the serum concentrations of IL-6[(27±10) pg/L] and TNF-α [(24±7) pg/L] were significantly lower in group Ⅲ than those in group Ⅱ[ (P＜0.05).Conclusion Gynecological laparoscopic operation using abdominal wall-lifting method can avoid the effect of CO2 pneumoperitoneum and reduce the stress response during operation.Compared to general anesthesia,less stress response was seen in patients under epidural anesthesia.