非心肺转流冠脉搭桥围术期IL-2和IL-4的变化

目的：研究两种复合全麻下，非心肺转流冠脉搭桥（OPCAB）围术期辅助性T淋巴细胞的免疫应激反应，方法：24例患者随分入丙泊酚－芬太尼全凭静脉麻醉组（P组）和异氟醚－芬太尼静吸复合麻醉组（Ⅰ组），于诱导前，术中打开心包和旁路血管开放时及术后2h采集血标本，应用放免法检测血清白细胞介素2（IL－2）和白细胞介素4（IL－4）的含量。结果：IL－2两组均减少，P组术中、术后均较诱导前有非常显著性降低（P＜0．01），Ⅰ组打开心包时降低明显（P＜0．05），旁路血管开放时降低更显著（P＜0．01）。两组相比，Ⅰ组IL－2于旁路血管开放时比P组下降更明显（P＜0．01）。旁路血管开放时，P组IL－4明显高于Ⅰ组（P＜0．05）。结论：丙泊酚－芬太尼静脉麻醉行OPCAB术对抑制免疫应激反应有益，是有利于机体的保护性免疫反应。

Changes of interleukin-2 and interleukin-4 in patients undergoing off-pump coronary artery bypass under general anesthesia

Objective To investigate the immune stress response of helper T lymphocyte (Th) to the off pump coronary artery bypass (OPCAB) under two general anesthesia methods.Methods Twenty four patients scheduled for elective OPCAB were randomly allocated to one of two groups:total intravenous anesthesia (group P)and isoflurane with fentanyl (group I).Arterial blood samples were collected before induction of anesthesia,at dissecting pericadia,opening bypass vessel,2hours after operation.Serum concentrations of interleukin 2 (IL 2) and interleukin 4(IL 4)were measured by radioimmunoassay.Results There was significantly decreased during and after operation compared with at before in IL 2 concentrations between tow groups ( P< 0 01),dissecting pericadiac and opening bypass vessel and 2 hours which was depressed more significantly in group I than in group P at opening bypass vessel( P< 0 01).Compared with group P,there was a significantly decrease in group I at opening bypass vessel ( P< 0 01).IL 4 was significantly higher in group P than that in group I at opening bypass vessel ( P< 0 05).Conclusions Total intravenous anesthesia with propofol could inhibit the immune reaction of Th lymphocyte to OPCAB more than isoflurane inhalation with fentanyl.