【摘要】 目的　研究异丙酚和异氟醚对开胸食管癌手术患者围术期炎性与抗炎性细胞因子平衡的影响。方法　择期食管癌手术患者 2 5例 ,随机分为两组。异氟醚组平均呼末浓度为 0 6 % ,异丙酚组微泵输入剂量为 6mg·kg-1·h-1。监测麻醉前、手术开始切皮时、进胸后 2h、鼓肺后 6 0min、术后 1h、4h、2 4h血清IL 6、IL 8、IL 10的浓度。观察围术期血液动力学变化及术后临床征象。结果　两组进胸后各时点IL 6、IL 8、IL 10的浓度均较术前显著增加 (P <0 0 1) ,炎性与抗炎性细胞因子分别于术后1h、4h达到高峰。IL 6组间比较无显著差异 ,异氟醚组膨肺后 6 0min至术后 4h各时点IL 8增加的幅度明显高于异丙酚组 (P <0 0 5 ) ,但术后 2 4h两组无差别。异丙酚组术后 1h、4h、2 4hIL 10的产生均显著高于异氟醚组 (P <0 0 5或P <0 0 1)。结论　临床剂量的异丙酚促进IL 10的产生 ,而异氟醚促进了IL 8的分泌 ,但麻醉选择对于细胞因子平衡的干预尚未影响到机体的免疫自稳。更多还原

【Abstract】 Objective To evaluate the effects of propofol and isoflurane on the change in periopreative serum IL 6,IL 8,IL 10 and the balance between pro and anti inflammatory cytokines.Methods Twenty five ASAⅡ Ⅲ patients scheduled for esophagus cancer surgery were randomly allocated to one of the two groups: isoflurane group(group I) and propoful group(group P). All patients were premedicated with oral diazepam 5mg and intramuscular atropine 0.3mg . In group P anesthesia was induced with propofol 1 2 mg·kg -1 ,fentanyl 2 μg·kg -1 ,midazolam 2 3 mg and vecuronium 0.1mg·kg -1 and maintained with propofol 5 10 mg·kg -1 ·h -1 , inhalation of nirous oxide (N 2O:O 2=50%:50%) and intermittent of boluses of vecuronium. In group I anesthesia was induced with 3% 4% isoflurane ,fentanyl 2μg·kg -1 ,midazolam 2 3mg, vecuronium 0.1mg·kg -1 and maintained with inhalation of 50% N 2O and isoflurane (ended tidal isoflurane was maintained at 0.6%) and intermittent boluses of vecuronium. During operation BP and HR were maintained with at ±20% of pre anesthesia level. After operation all patients received PCEA with 0.15% bupivacaine and fentanyl 2μg·ml -1 . Blood samples were taken from internal jugular vein before anesthesia (T 0), at skin incision(T 1), 2h after thoracotomy (T 2), 60min after lung were inflated(T 3),1,4 and 24h after operation(T 4,5,6 ) for determination of serum IL 6,IL 8 and IL 10 concentrations. Results All patients showed significant increases in IL 6, IL 8 and IL 10 levels during thoracotomy (P<0.01). The pro inflammatory cytokine IL 6 levels were similar in both groups, whereas intraoperative IL 8 level was higher in the isoflurane group. The anti inflammatory cytokine IL 10 level was higher after surgery in propofol group than that in isoflurane group(P<0.05). Conclusions The perioperative cytokine response to surgical trauma can be modified by the choice of anesthetics.更多还原