异丙酚对脊柱外伤患者围手术期血清相关细胞因子的影响

目的研究异丙酚在脊柱外伤患者围手术期应用对血清相关细胞因子的影响。方法脊柱外伤患者65例按手术时采用的麻醉药物不同分为异丙酚组（n=35）和依托咪酯组（n=31）两组，在诱导麻醉过程中，两组均在应用芬太尼和维库溴铵前提下，异丙酚组加用异丙酚，而依托咪酯组则加用依托咪酯。麻醉维持吸入异氟醚，间断追加异丙酚或依托咪酯、芬太尼和维库溴铵。两组患者均于术前、诱导后、手术开始30min以及术毕抽静脉血离心提取血清，用放射免疫法测定丙二醇（MDA）、超氧化物歧化酶（SOD）、白细胞介素-6（IL-6）、肿瘤坏死因子（TNF）、血栓素（TX）、内皮素（ET）、前列腺素E（PGE）和降钙素（CT）水平。结果两组患者麻醉过程中生命体征平稳，无麻醉相关死亡。术前两组患者血清MDA、SOD、IL-6、TNF，TX、ET、PGE和CT均无统计学差异（P〉0．05），诱导后异丙酚组上述各指标均明显降低（P〈0．05），且随手术时间推延，差异更明显（P〈0．01）。结论脊柱外伤手术采用异丙酚麻醉，能够降低术中血清相关细胞因子水平，从而影响机体的生化代谢，其机理有待进一步探讨。

Effects of propofol on serum-related cytokines for patients with spinal injury in perioperative period

Objective To investigate the effects of propofol on serum-related cytokines for patients with spinal injury in perioperative period and to discuss its clinical significance. Methods Totally 65 patients with spinal injury were divided into the propofol group （ n = 35 ） and the etomidate group （ n = 31 ） according to the use of anesthesia drugs in surgery. Fentaini and veeuronium were applied to both groups during the process of anesthetizing, however, propofol was used in the propofol group and etomidate was used in the etomidate group. Isoflurane was consistently inhaled during the anesthesia and propofol, fentaini and vecuronium were interruptedly supplied. The venous blood was collected to extract the serum through eentrifugation at 30 minutes intra-operation and after the operation finished. Serum malonic dialdehyde （MDA） , superoxide dismutase （ SOD ） , interleukin-6 （ IL-6 ） , tumor necrosis factor （ TNF ） , thromboxane （ TX ） , endothelin （ ET ） , prostaglandin E （PGE） and calcitonin （CT） were determined by radioimmunoassay（RIA）. Results The vital signs were stable in the two groups of during the anesthesia without anesthesia-related deaths. The serum MDA, SOD, IL-6, TNF, TX, ET, PGE and CT were not statistically different between the two groups before the operation （P 〉 0.05 ）. After the induction, the above indicators in the propofol group were obviously reduced （ P 〈 0.05 ） and in a time-dependent manner （ P 〈 0.01 ）. Conclusion Propofol anaesthesia can reduce serum-related cytokine levels in patients with spinal injury in perioperative period,thus affect organism biochemistry metabolism. Its mechanism needs further discussing.