【摘要】 目的　比较不同剂量芬太尼对心肺转流 (CPB)心脏手术患者围术期血浆C 反应蛋白(CRP)及肿瘤坏死因子 α(TNF α)、白细胞介素 8(IL 8)、白细胞介素 10 (IL 10 )水平的影响。方法　随机、双盲将择期心脏手术患者 2 4例分为两组 ,一组为芬太尼 0 0 2 5mg/kg组 (A组 ) ,另一组为芬太尼 0 0 1mg/kg组 (B组 ) ,每组 12例。分别于全麻诱导前 (基础 ,T0 )、主动脉开放后 (T1)、CPB停机后 (T2 )、术毕 (T3 )、术后 2 4h(T4)、术后 4 8h(T5)抽取患者中心静脉血 ,采用放射免疫法定量测定CRP、TNF α、IL 8和IL 10的血浆水平。结果　A组和B组TNF α在T0 、T1、T2 、T3 、T4、T5血浆浓度相比较无显著性差异 (P >0 0 5 )。CRP在T4时 ,A组高于B组 (P <0 0 5 )。IL 8血浆浓度在T0时A组值高于B组 (P <0 0 5 )。IL 10在T0 、T1,B组高于A组 (P <0 0 5 )。两组TNF α其他时点与T0 相比 ,无显著性差异 (P >0 0 5 )。CRP在两组中T4、T5与T0 相比均有显著升高 (P <0 0 5 )。IL 8在A组除T1外各个时点与T0 比均有显著升高 (P <0 0 5 ) ,在B组中除T5外各个时点值与T0 相比均有显著升高 (P <0 0 5 )。IL 10在A组中 ,各时点与T0 相比较均有显著升高 (P <0 0 5 ) ,而在B组中除T5外其他各时点血浆浓度值与T0 相比 ,无显著更多还原

【Abstract】 Objective A comparison of the effects of different fentanyl doses on serum level of CRP, TNF-α, IL-8, and IL-10 in patients undergoing cardiac surgery.Methods Twenty-four patients scheduled for cardiac surgery with CPB were divided into two groups. Patients received a induction dose of 0.025 mg/kg of fentanyl followed by an intravenous infusion of 0.025 mg·kg -1·h -1 for maintenance of the general anesthesia in group A or 0.01 mg/kg of fentanyl for induction and 0.025 mg·kg -1·h -1 for maintenance in group B. The standardized anaesthetic also included vecuronium and midazolam. Blood samples for cytokines and CRP measurements were collected into EDTA-vacutainers from central vein at the following time points: just prior to induction of anesthesia (baseline, T 0), 5 min after aortic cross-clamp release (T 1), 5 min after weaning from CPB (end-CPB, T 2), on completion of surgery (T 3), 24 hours (T 4) and 48 hours (T 5) after the operation. The concentrations of CRP, TNF-α, IL-8, and IL-10 on blood serum were measured by radio immunoassay (RIA).Results Patients in group A had a significant increase in T 4,T 5 CRP, T 2-T 5 IL-8 and T 1-T 5 IL-10 (P< 0.05) and patients in group B had a significantly higher in T 4, T 5 CRP, T 1-T 5 IL-8 and T 5 IL-10 compared with the baseline (P< 0.05). The level of TNF-α at T 0-T 5 was not significantly different between group A and B. CRP at T 4 and IL-8 at T 0 were significantly higher in group A than that in group B. CRP at T 1 and IL-10 at T 2 were significantly lower in group A compared with that in group B. Conclusion A balanced anesthesia with fentanyl in an induction dose of 0.025 mg/kg followed by an intravenous infusion of 0.025 mg·kg -1·h -1 for maintenance of the general anesthesia offered advantage over 0.01 mg/kg of fentanyl for induction and 0.025 mg·kg -1·h -1 for maintenance on reducing systemic inflammatory response in patients undergoing cardiac surgery with CPB.更多还原