不同麻醉方法对颅内肿瘤患者炎症因子的影响

目的观察丙泊酚、异氟醚对颅内肿瘤患者炎症因子C-反应蛋白(C-reactive protein,CRP)、补体C3(complement C3,C3)及白细胞介素-6(IL-6)的影响,并探讨丙泊酚脑保护作用的机制。方法择期全麻下行颅内肿瘤手术患者106例,年龄35～60岁,体质量39～82 kg,根据美国麻醉医师协会(american society of anesthesiologists,ASA)的分级为Ⅰ或Ⅱ级颅内肿瘤患者,按性别随机分为丙泊酚组和异氟醚组,每组各53例。丙泊酚组采用血浆靶控输注丙泊酚3～6 mg.L-1,异氟醚组使用质量分数为1.0%～2.0%的异氟醚持续吸入,两组术中均按需静脉给予芬太尼和维库溴铵,并于手术结束前5 min分别停止丙泊酚输注和异氟醚吸入。两组均于麻醉诱导前、术后0、24、48 h各时点抽取静脉血,测定血清中CRP、C3和IL-6的含量。结果丙泊酚组和异氟醚组患者血清中CRP、C3和IL-6的含量术后均呈上升趋势,各指标差别均具有统计学意义(均P<0.01)。其中术后0～48 h丙泊酚组和异氟醚组CRP及IL-6的含量均较麻醉诱导前时明显升高(P<0.05);丙泊酚组和异氟醚组C3的含量术后24、48 h均较诱导前时明显升高(P<0.05),术后0 h与麻醉诱导前比较其差别均没有统计学意义(P>0.05);麻醉诱导前丙泊酚组与异氟醚组比较,CRP、C3和IL-6的含量差别均无统计学意义(P>0.05);术后0 h时,丙泊酚组与异氟醚组比较,C3和IL-6的含量差别均无统计学意义(P>0.05),而丙泊酚组CRP含量明显低于异氟醚组(P<0.01);术后24、48 h,丙泊酚组与异氟醚组比较,CRP、C3和IL-6的含量间差别均有统计学意义(P<0.05)。结论丙泊酚靶控输注比异氟醚吸入可更好地降低颅内肿瘤患者术后炎症水平,这可能也是丙泊酚发挥脑保护作用的机制之一。

Effect of different anesthesia on inflammatory factors in the intracranial neoplasms

Objective To investigate the influence of anesthesia methods and anesthetics on inflammatory factors in the intracranial neoplasms.Methods One hundred six ASA Ⅰ or Ⅱ patients undergoing for selective intracranial neoplasms surgery were randomly divided into two groups with 53 cases for each.The patients in the group of propofol were given intravenous anesthesia with target controlled infusion of propofol 3-6 mg · L-1,those in the group of isoflurane received inhalation anesthesia with isoflurane 1%-2%.C-reaction protein(CRP),(complement C3(C3)and IL-6 were recorded before anesthesia,0 h,24 h,and 48 h after operation.Results The serum levels of CRP and IL-6 were significantly increased at 0 h,24 h,and 48 h after operation compared with those before anesthesia in both groups(all P<0.05).The C3 levels were significantly higher at 24 h and 48 h after operation than those before anesthesia in both groups(all P<0.05).The serum levels of CRP,C3 and IL-6 were significantly lower in the group of propofol than those in the group of isoflurane at 24 h and 48 h after operation(all P<0.05).Conclusions The effect of propofol was better than that of isoflurane in inhibiting inflammatory reaction in patients with intracranial neoplasms.