原位肝移植术中雷米芬太尼对机体应激反应的影响

目的比较原位肝移植手术中雷米芬太尼和芬太尼对机体应激反应的影响。方法 30例行择期原位肝移植手术的患者随机分为雷米芬太尼组(A组,n=15)和芬太尼组(B组,n=15)。分别于开腹后30min(T)1,门静脉阻断后20min(T)2,门静脉开放后30min(T)3和关腹时(T)4采深静脉血检测TNF-α,IL-6和血清皮质醇浓度。结果两组组内比较,芬太尼组和雷米芬太尼组在T2,T3时刻,皮质醇浓度都明显升高(P<0.05);T3时刻IL-6浓度明显升高(P<0.01)。两组组间比较,芬太尼组在T2,T3时刻的皮质醇浓度明显高于雷米芬太尼组(P<0.05);芬太尼组在T2时刻的TNF-α浓度明显高于雷米芬太尼组(P<0.05);芬太尼组在T3时刻的IL-6浓度明显高于雷米芬太尼组(P<0.05)。结论肝移植术中使用雷米芬太尼能降低肝移植手术中的皮质醇、TNF-α和IL-6水平,对减轻肝移植手术应激反应可能有一定的作用。

Effect of remifentanil on the stress of orthotopie liver transplantation

Objective To compare the effects of remifentanyl and fentanyl oh the stress of orthotopic liver transplantation. Methods Thirty elective orthotopic liver transplantation patients were divided into remifentanyl group （group A,n=15） and fentanyl group （group B,n=15） randomly. The concentrations of TNF-α,IL-6 and serum cortisol on the time of opening abdominal 30 minutes later （T1）, portal vein blocking 20 minutes later （T2）, portal vein opening 30 minutes later （T3） and closing abdomen （T4） were determined. Results In comparison, the cortisol concentration significantly increased in T2 and T3 moments of the two group （P〈0.05）.The IL-6 concentration significantly increased in T2 and T3 moments of group B than group A （P〈0.01）. In T3 moment the IL-6 concentration significantly rised in group B. Conclusion Remffentanyl.can reduce the concentration of cortisol, TNF-α and IL-6 on liver transplant, and decrease the operative stress.