不同麻醉方法对大肠癌手术患者血浆IL-17和IL-23浓度的影响

目的：比较大肠癌手术中连续硬膜外复合静脉麻醉、全凭静脉麻醉和全凭吸入麻醉对患者血浆促炎性细胞因子IL-17和IL-23的影响。方法：2013年1月至2014年12月在本院接受择期大肠癌根治术的患者60例作为实验组，随机分成3组：连续硬膜外复合静脉麻醉组（A组，布比卡因连续硬膜外泵注维持麻醉，复合丙泊酚静脉泵注镇静）、全凭静脉麻醉组（B组，术中静脉泵注丙泊酚镇静，芬太尼镇痛）、全凭吸入麻醉组（C组，术中吸入笑气、氧气和七氟烷维持麻醉。对照组由健康体检者组成。ELISA法检测血浆细胞因子IL-17和IL-23浓度。结果：麻醉诱导前（T0）试验组患者血浆IL-17和IL-23浓度较对照组明显升高，试验组间差异无统计学意义（P＞0.05）；与T0时间点相比，手术开始后60 min（T1）、术后30 min（T2）和术后24 h（T3）试验组患者血浆IL-17和IL-23浓度明显降低，其中上述指标T1时明显低于T2和T3时，T2时明显低于T3时，差异均有统计学意义（P＜0.05）；与C组相比，T1、T2时间点A、B 2组患者血浆IL-17和IL-23浓度明显降低，且A组上述指标明显低于B组，差异有统计学意义（P＜0.05）；而在T3时间点试验组差异无统计学意义（P＞0.05）。结论：3种麻醉方法均可明显抑制IL-17和IL-23释放，故对大肠癌有抑制作用，其中连续硬膜外复合静脉麻醉好于全凭静脉麻醉，全凭静脉麻醉好于全凭吸入麻醉。

IL-17 and IL-23 serum levels in patients undergoing colorectal cancer surgery: effects of different anesthetic techniques

Objective: To compare the effects of continuous epidural block combined with intravenous anesthesia, total intravenous anesthesia and total inhalational anesthesia on pro-inflammatory cytokines IL-17 and IL-23 serum levels in patients undergoing colorectal cancer surgery. Methods: All patients were randomly divided into three trials groups (n=20): continuous epidural block combined intravenous anesthesia group (A group): patients received continuous epidural anesthesia of bupivacaine, and received intravenous anesthesia with propofol; total intravenous anesthesia group (B group): patients received total intravenous anesthesia with propofol and fentanil; total inhalational anesthesia group (C group): patients received total inhalational anesthesia with sevoflurane in O2 and Nitrous Oxide. Control group was composed of healthy subjects. Serum levels of IL-17 and IL-23 were quantified. Results: In three trials groups, levels of IL-17 and IL-23 were high prior to control group at induction of anesthesia (T0), and there was no difference between three groups (P>0.05). Compared with T0, levels of IL-17 and IL-23 significantly decreased at 60 min after the start of surgery (T1), 30 min post-surgery (T2) and 24 h post-surgery (T3); Levels of IL-17 and IL-23 were significantly lower at T1 than T2 and T3, and they were significantly lower at T2 than T3 (P<0.05). At T1 and T2, levels of IL-17 and IL-23 were significantly lower in A group than that in B group, and they were significantly lower in B group than C group (P<0.05); there was no difference between three trials groups at 24 h post-surgery (P>0.05). Conclusion: Three anesthetic techniques significantly decreases IL-17 and IL-23 levels, so they has inhibiting effect on colorectal cancer. In this respect, continuous epidural block combined with intravenous anesthesia is better than the other two, total intravenous anesthesia is better than total inhalational anesthesia.