异丙酚对肝移植术患者围术期血清TNF-α、IL-6和IL-10浓度的影响

目的 探讨异丙酚对肝移植术患者围术期血清TNF-α、IL-6和IL-10浓度的影响.方法 择期原位经典肝移植术患者20例,年龄38～52岁,ASA Ⅲ级,肝功能Child评分5～11分,随机分为2组(n=10):异丙酚组(P组)于麻醉诱导后即刻静脉注射异丙酚0.5 mg/kg,然后静脉输注2 mg·ks-1·h-1至术毕;对照组(C组)给予生理盐水.于麻醉诱导后即刻(T1)、无肝期之前5 min(T2)、新肝期之前5 min(T3)、新肝期15min(T4)、新肝期60min(T5)、新肝期3 h(T6)和术后4 h(T7)时,采集静脉血3 ml,采用酶联免疫吸附法测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-10(IL-10)浓度.结果 与T1时比较,2组T2-7,时血清TNF-α、IL-6和IL-10浓度升高(P＜0.05或0.01);与C组比较,P组,T1-7时血清TNF-α和IL-6浓度降低,T4时血清IL-10浓度降低(P＜0.05或0.01).结论 异丙酚可明显抑制肝移植术患者血清TNF-α和IL-6的释放,对IL-10无影响.

Effects of propofol on perioperative serum TNF-α.IL-6 and IL-10 concentrations in patients undergoing orthotopic liver transplantation

Objective To investigate the effects of propefol on perioperative 8erum TNF-α,IL-6 and IL-10 concentrations in patients undergoing orthotopic liver transplantation(OLT).Methods Twenty ASA Ⅲ patients(their Child-Pugh score ranged between 5-11)aged 38-52 yr undergoing elective OLT were randomly divided into 2 groups(n=10 each):control group(C)and propofol group(P).Anesthesia was induced with midazolam 0.1-0.2 mg/kg,fentanyl 2-4 μg/kg,etomidate 0.2-0.3 mg/kg and vecuronium 0.1 ms/kg and maintained with 1%-2% isoflurane and intermittent iv boluses of fentanyl and vecuronium.The patients were mechanically ventilated after tracheal intubation.PETCO2 was maintained at 30-45 mm Hg.In group P a bolus of propefol 0.5 mg/kg Was given iv immediately before operation followed by continuous infusion of propofol at 2 mg· kg-1·h-1 until the end of operation;while in group C normal saline(NS)was infused instead of propofol.Blood samples were taken immediately after induction of anesthesia(T1,baseline),at 5 min before anhepatic phase(T2) and 5 min before neohepatic phase(T3),15 min(T4),60 min(T5)and 3 h(T6)of neohepafic phase and at 4 h after the end of operation(T7)for determination of serum TNF-α,IL-6 and IL-10 concentrations.Results The 2 groups were comparable with respect to age,sex ratio,.body weisht,cold and warm ischemia time,anhepatic phase,operation time,intraoperative blood loss and amount of blood infused.The serum TNF-α,IL-6 and IL-10 concentrations were significantly increased at T2-7 compared with the baseline at T1 in both groups.The serum TNF-α and IL-6 concenffafions at T1-7 and the serum IL-10 concentration at T4 were significantly lower in group P than in group C. Conclusion Propofol can inhibit the release of TNF-α and IL-6 but has no effect on IL-10 release.