外科及移植和麻醉应激对机体细胞因子活性的影响

背景：外科患者的康复过程是否顺利与多种因素有关，其中免疫因素是重要因素之一，细胞因子是免疫功能的主要组成，也是近年来研究的热点，手术的精神刺激、麻醉刺激、手术实质刺激、术后麻醉手术反应刺激等都可导致患者体内细胞因子发生改变，从而影响患者的康复。 目的：综述外科及移植和麻醉应激对机体细胞因子活性的影响。 方法：由一作者应用计算机检索2005-01/2010-10万方、维普、龙源期刊网、中国知网相关文章，中文检索词为“手术，麻醉，细胞因子”，英文检索词为“surgery，anesthesia，cytokines”。共检索到文献72篇，最终纳入符合标准的文献26篇。 结果与结论：手术可导致机体细胞因子失衡，尤其是白细胞介素6、白细胞介素10、白细胞介素1、白细胞介素2、白细胞介素8、肿瘤坏死因子α变化(增高)明显；传统手术与腹腔镜手术相比，后者细胞因子变化不明显，说明细胞因子变化与机体损伤程度有关。全麻也可导致机体细胞因子失衡，而硬膜阻滞麻醉对细胞因子影响不明显。手术、创伤、全麻都可以导致体内细胞因子失衡，从而影响机体免疫系统、内分泌系统等，进而影响机体的康复；硬膜阻滞麻醉/硬膜阻滞麻醉辅助其他麻醉对机体细胞因子平衡影响较少。在外科临床工作中，进行外科手术时尽量选择创伤小的麻醉和手术方法。

Influence of transplant surgery and anesthesia stress on the activity of body cytokines

BACKGROUND:Whether the patients can successfully recover is related to many factors, among which immune factor is an important one. Cytokine is a major component for immune function and also a research hotspot in recent years. Mental stimulation, anesthesia stimulation, real stimulation in surgery, and anesthesia reaction stimulation after surgery can lead to a change in patients’ body cytokines, which affects the patient’s recovery. OBJECTIVE:To review the influence of transplant surgery and anesthesia stress on the activity of body cytokines. METHODS:A computer search was performed for relative articles in Wanfang, VIP, Qikan, and CNKI databases from January 2005 to October 2010. The key words are “surgery, anesthesia, cytokines” in Chinese and English. There were altogether 26 documents retrieved. RESULTS AND CONCLUSIONS:There were 26 relative literature retrieved, with one involving the basic theory, 19 about surgery, and 6 related to anesthesia. It is found that surgery can cause imbalance of body cytokines, especially with interleukin (IL)-6, IL-10, IL-1, IL-2, IL-8, tumor necrosis factor (TNF)-α changing (increased) significantly. Compared with conventional surgery, the change of cytokines in laparoscopic surgery is relatively not obvious, which indicates cytokine changes are related to the degree of body damage. Anesthesia can also lead to imbalance of the body cytokines, mainly with IL-6, IL-10, TNF-α changing (increased), while epidural anesthesia has no obvious effect on cytokines. Surgery, trauma and general anesthesia can lead to cytokine imbalance, thus affecting the immune system and endocrine system, etc, and further influencing the rehabilitation of the body. Epidural anesthesia/epidural anesthesia assists other narcotic effect on cytokine balance in the body less. In clinical surgery work, we should try to choose a small trauma and surgical method during anesthesia.