异丙酚或安氟醚复合麻醉下胆道手术患者围术期中性粒细胞凋亡的变化

Perloperative changes in neutropbil apoptosis In patients undergoing operation under propofol or enflurane balanced anesthesia

目的 探讨异丙酚或安氟醚复合麻醉下胆道手术患者围术期中性粒细胞(PMN)凋亡的变化及机制。方法 择期行胆道手术的非肿瘤患者43例,ASA Ⅰ-Ⅱ级,年龄26-57岁,随机分为两组:异丙酚复合麻醉组(P组,n=22)及安氟醚复合麻醉组(E组,n=21)。另选择健康成年人16例作为对照组(C组)。分别于手术前(T1)、手术开始即刻(T2)、手术开始后1.5 h(T3)、3 h(T4)、24 h(T5)取外周静脉血5 ml,检测PMN凋亡率及Bcl-2表达百分率。结果 与C组比较,P组、E组T1时外周血PMN凋亡率明显降低,而Bcl-2表达百分率明显增高(P<0.01)。与T1比较,P组、E组患者在T2、T3、T4、T5时PMN的凋亡率下降,而Bcl-2表达百分率增高(P<0.01);与E组比较,P组在T3、T4、T5时PMN凋亡率增高,而Bcl-2表达百分率降低(P<0.05或0.01)。Bcl-2表达百分率与PMN凋亡率的相关系数为-0.6922(P<0.01)。结论 异丙酚或安氟醚复合麻醉下胆道手术患者围术期PMN凋亡延迟,且异丙酚复合麻醉患者凋亡延迟较轻,其机制与PMN Bcl2基因上调程度有关。

Objective To investigate the perioperative changes in neutrophil (PMN) apoptosis in patients undergoing billiary tract operation under propofol of enflurane balanced anesthesiaMethods Forty-three ASA Ⅰ- Ⅱ non-cancer patients (26 male, 17 female) aged 26-57 yrs weighing 50-80 kg were randomized to receive either propofol ( n = 22) or enflurane ( n = 21) balanced anesthesia. Sixteen healthy volunteers served as control. The patients were premedicated with intramuscular luminal 2 mg · kg-1 and atropine 10 μg· kg-1 . Anesthesia was induced with propofol 1.5-2.5 mg·kg-1 , fentanyl 4 μg·kg-1 and vecuronium 0.2 mg·kg-1 and maintained with propofol infusion at 6-10 mg·kg-1·h-1 (propofol group, P) or enflurane (1-3%) (enflurane group, E) supplemented with intermittent i.v. boluses of fentanyl and vecuronium. Blood samples were taken from peripheral vein before anesthesia (T1), 30 min after induction of anesthesia and before skin incision (T2), 1.5 h after skin incision (T3 ), 3 h after operation (T4 ) and 24 h after operation (T5 ) . Neutrophil apoptosis and Bcl-2 gene expression were assessed by flow cytometry. Results The percentage of neutrophil apoptosis was significantly lower while Bcl-2 gene expression significantly higher in patients scheduled for billiary tract operation than in healthy volunteers (P < 0.01) . The percentage of neutrophil apoptosis was decreasing while Bcl-2 gene expression increasing during and after operation in both group P and ? The percentage of neutrophil apoptosis was significantly higher, while Bcl-2 gene expression significantly lower at T2, 3, 4 in group P than in group E (P < 0.01, 0.05) .Conclusion The spontaneous neutrophil apoptosis can be delayed perioperatively in patients undergoing billiary tract operation under propofol or enflurane balanced anesthesia, with the less degree under propofol balanced anesthesia due to reduction in Bcl-2 gene expression up-regulation in PMNs.