不同麻醉方式对全髋置换术患者炎性细胞因子的影响

目的　双盲对比观察硬膜外麻醉与全麻下全髋置换手术病人围术期血清肿瘤坏死因子( TNF- α)、白细胞介素 - 6 ( IL- 6 )、白细胞介素 - 8( IL- 8)、白细胞介素 - 10 ( IL- 10 )水平的动态变化 ,分析手术麻醉对患者免疫力的影响。方法　选择 30例 ASA ～ 级择期行全髋置换术的病人 ,按麻醉方式的不同随机分成硬膜外麻醉组及全麻组 (每组 15例 ) ,记录术中患者生命体征、手术时间、术中的出血量与输血量及不同时间 ,外周血清中 TNF-α、IL - 6、IL - 8、IL - 10水平。结果　所有患者术中血流动力学指标均稳定。两组 TNF-α没有明显变化 ;硬膜外麻醉组 IL - 6在手术开始后 30 min及术毕明显升高 ( P<0 .0 5 ) ;IL - 8在术后第 1天达高峰 ,至术后第 2天仍高于正常 ;IL- 10在术后第 1天、第 2天水平较术前明显下降 ( P<0 .0 5 ) ;全麻组 IL- 6在手术开始后 30 min及术毕升高 ,与术前值比较差异无显著性 ( P>0 .0 5 ) ,但明显小于硬膜外麻醉组同时点值 ( P<0 .0 5 ) ,IL- 8在术后第 1天达高峰 ,至术后第 2天恢复于术前水平 ;IL- 10在术后第 1天、第 2天水平较术前有所下降 ,但差异无显著性。结论　手术创伤可引起促炎性细胞因子释放增加及抗炎性细胞因子分泌的不足 ,全身麻醉能更好地抑制促炎性细胞因子的释?

Changes of perioperative serum levels of tumor necrosis factor-α,interleukin-6,interleukin-8 and interleukin-10 in patients undergoing total hip replacement under epidural or general anesthesia

Objective To investigate the change of perioperative serum levels of tumor necrosis factor α(TNF α),interleukin 6 (IL 6),interleukin 8 (IL 8) and interleukin 10 (IL 10) in the patients undergoing total hip replacement under epidural or general anesthesia.Methods Thirty ASA Ⅰ～Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups according to the way of anesthesia:epidural anesthesia group and general anesthesia group.The serum TNF α,IL 6,IL 8 and IL 10 were measured before operation,at 30 min after skin incision,at the end of operation,and on the 1st and 2nd postoperative days.Vital signs,the duration of operation and blood loss were also recorded.Results Hemodynamic indices of all the cases kept stable during the operation.There were no significant changes of TNF α during the operation in the two groups.In epidural group,compared with that before operation,the serum IL 6 increased significantly at 30 min after skin incision and at the end of operation and then gradually decreased,the serum IL 8 increased significantly on the 1st and 2nd postoperative days,and serum IL 10 decreased significanlly on the 1st and 2nd postoperative days.In general anesthesia group,the serum IL 6 increased at 30 min after skin incision and at the end of operation,there is no significant difference compared with that before operation,but it was significantly lower than that of epidural anesthesia.Both in the two groups,serum IL 10 decreased on the 1 st and 2nd postoperation days.Conclusion Surgery and anesthesia can lead to increasing the release of inflammatory cytokine,which may result from the insufficient secretion of anti inflammatory cytokine.General anesthesia can suppress the release of inflammatory cytokine more effectively than epidural anesthesia.