靶控输注异丙酚对心脏瓣膜置换术患者炎性细胞因子浓度变化的影响

目的探讨体外循环下心脏瓣膜置换术靶控输注异丙酚后对患者炎性细胞因子浓度的影响。方法择期行心脏瓣膜置换术患者60例，美国麻醉医师协会分级Ⅱ-Ⅲ级，随机分为异丙酚组和对照组，每组30例。异丙酚组在麻醉诱导后靶控输注初始血浆药物靶浓度为2．5ug／mL的异丙酚，根据麻醉深度调整异丙酚血浆靶浓度，最大可达3．4ug／mL；同时复合枸橼酸芬太尼、维库溴铵维持麻醉。对照组术中间断静注咪唑安定、枸橼酸芬太尼、维库溴铵维持麻醉。分别于麻醉诱导后、主动脉阻断后30min、主动脉开放时、体外循环停机后30min、体外循环停机后90min抽取患者中心静脉血，用酶联免疫吸附法测定血清肿瘤坏死因子α（TNF-α）、白介素8（IL-8）、白介素10（IL-10）的浓度。结果两组在体外循环期间血清TNF—α、IL-8浓度均显著升高，对照组明显高于异丙酚组（P〈0．01）；血清IL-10的浓度均显著升高（P〈0．01），但对照组明显低于异丙酚组（P〈0．01）。结论异丙酚可通过抑制促炎性细胞因子的合成和激活抗炎性细胞因子的释放，减轻机体逐级放大反复加重的过度失控的全身炎症反应，对机体发挥保护作用。

Effects of propofol by target-controlled infusion on the changes in the plasma levels of proinflammatory cytokines in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To evaluate the effect of propofol by target-controlled infusion on the changes in the plasma levels of proinflammatory cytokines. Methods Sixty American Society of Anesthesiologists Ⅱ-Ⅲ patients undergoing cardiac valve replacement were randomly divided into experimental group （n=30） and control group （n=30）. Anesthesia was induced with midazolam, fentanyl and vecuronium in experimental groups a loading dose of propofol. After induction of anesthesia 1 min, after aortic-clamping 30 min, after aotic-off clamping 1 min, after stopping cardiopulmonary bypass 30 min and 90 min, blood samples were taken from central vein to measure the plasma levels of tumor necrosis factor α （TNF-α）, interleukin 8 （IL-8） and IL-10. Results The levels of TNF- α and IL-8 in two groups increased significantly during cardiopulmonary bypass in both groups （P 〈0.05; P 〈0.01） and the levels were significantly higher in control group compared with experimental group （P 〈0.01）. The levels of IL-10 in two groups increased significantly during cardiopulmonary bypass （P 〈0.01） and the levels were significantly higher in experimental group compared with control group （P 〈0.01）. Conclusion Because propofol can inhibit the activity and the release of the proinfiammatory cytokines, activate the activity and the release of anti-inflammatory cytokines it may protect the injured human body.