地氟醚和七氟醚麻醉对肝癌患者围术期血浆细胞因子水平的影响

目的：探讨地氟醚和七氟醚吸入麻醉对肝癌患者围术期血浆细胞因子的影响。方法：原发性肝癌患者100例，ASAⅠ-Ⅱ级，男60例，女40例，年龄41~82岁，体重50~83kg，随机分为地氟醚组（D 组）和七氟醚组（S 组），每组50例患者择期行超声引导下经皮肝穿刺肝癌射频消融术。麻醉诱导后行气管插管连接麻醉机辅助呼吸，麻醉维持使 BIS 于40~60，BP、HR 高于基础值20%以上时，追加5~10μg 舒芬太尼，适时追加罗库溴铵。分别于麻醉诱导前（T0）、手术开始时（T1）、手术结束时（T2）及术后24h（T3），采集静脉血，应用酶联免疫吸附（ELISA）方法测定血清 IL -4、IL -10、HMGB1及 VEGF -1浓度。结果：T0、T1、T2和 T3时间点，D 组与 S 组血浆中细胞因子 IL -4、IL -10、HMGB1和 VEGF -1水平均随时间升高，T3时间点血浆中细胞因子浓度达到释放高峰。在各个时间点，两组患者血浆中 IL -4、IL -10、HMGB1和 VEGF -1水平差异无统计学意义（P ﹥0.05）。结论：七氟醚和地氟醚麻醉对肝癌患者围术期血浆细胞因子水平影响无明显区别，是肿瘤患者较好的麻醉药物，有利于改善肿瘤患者的预后。

Effects of desflurane and sevoflurane on plasma cytokines in liver cancer patients during perioperative period

Objective:To investigate the effects of desflurane and sevoflurane on plasma cytokines in liver cancer patients during perioperative period. Methods:One hundred ASAⅠ - Ⅱpatients,60 male and 40 female,aged 41 ~82,were randomly assigned to two groups:desflurane group(Group D)and sevoflurane group(Group S). 50 patients of each group underwent elective percutaneous liver puncture radiofrequency ablation of liver cancer with ultrasound. After anesthesia induction,patients were made endotracheal intubation to breathe through anesthesia machine,and maintained with BIS 40 ~ 60,when BP and HR were 20% higher than the basic value of them,we used an additional 5 ~ 10μg sufentanyl with timely supplementary rocuronium. Blood samples were collected from peripheral vein before anesthesia(T0),the beginning of operation(T1),the end of operation(T2)and 24h after operation(T3)for determi-nation of plasma IL - 4,IL - 10,HMGB1 and VEGF - 1 using ELISA. Results:At In T0,T1,T2 and T3 time points, the concentration of IL - 4,IL - 10,HMGB1 and VEGF - 1 were increased with time,and the peak concentration of them was T3 time point. The levels of IL - 4,IL - 10,HMGB1 and VEGF - 1 had no significant difference between the two groups D and S in all time points(P ﹥ 0. 05). Conclusion:Sevoflurane and desflurane anesthesia had no dif-ferent effects on the release of IL - 4,IL - 10,HMGB1 and VEGF - 1 in liver cancer patients during perioperative pe-riod,which are better anesthetics and improves the prognosis in cancer patients.