丙泊酚镇静对全子宫切除术患者血浆细胞因子的影响

Effects of propofol sedation on plasma cytokines in hysterectomic patients

目的 以咪唑安定镇静作为对照,研究丙泊酚镇静对硬膜外麻醉下行全子宫切除术患者手术前后血浆细胞因子变化的影响。方法30例硬膜外麻醉下择期行全子宫切除术患者,ASAⅠ～Ⅱ级,随机分为三组(每组10例):对照组,术中未给予任何镇静药物;咪唑安定组,切皮前静脉注射咪唑安定0.1 mg/kg,继之以微泵输注,输注速度为0.1mg·kg-1·h-1;丙泊酚组,切皮前静脉注射丙泊酚2.0 mg/kg,继之以微泵输注,输注速度为3.0mg·kg-1·h-1。分别调节丙泊酚和咪唑安定的输注速度和输注量,使患者的Ramsay镇静评分约为3分。抽取患者外周静脉血检测术前和术后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和白细胞介素-10(IL-10)的浓度。结果三组患者术后血浆中TNF-α、IL-6、IL-8和IL-10的浓度与术前相比均明显升高(P<0.05)。术后血浆TNF-α、IL-6、IL-8浓度升高的幅度,丙泊酚组明显低于对照组和咪唑安定组,咪唑安定组明显低于对照组(P<0.05);IL-10浓度升高的幅度,丙泊酚组明显高于对照组和咪唑安定组(P<0.05),咪唑安定组与对照组无显著性差异。结论 丙泊酚镇静可降低患者的应激反应而有效缓解手术创伤和麻醉对患者机体免疫功能的抑制。

Objective To investigate the effects of propofol sedation on plasma cytokines in hysterectomic patients. Methods Thirty ASA Ⅰ-Ⅱ patients, scheduled for hysterectomy under epi-dural block were randomly divided into three groups. The patients in control group(n=10) received no sedatives,in propofol group(n=10)propofol 2. 0 mg/kg was injected before incision and infused at a rate of 3. 0 mg · kg-1 · h-1 during operation,and in midazolam group (n=10) midazolam 0. 1 mg/kg before incision and 0. 1mg · kg-1· h-1 during operation. The infusion rate of the sedatives was regulated in order to keep the patients' Ramsay scores about 3. The plasma cytokines were measured before and after operation. Results Plasma TNF-α,IL-6,IL-8 and IL-10 were increased significantly in all groups postoperatively(P<0. 05). Plasma TNF-α,IL-6 and IL-8 in propofol group were significantly lower than those in control and midazolam groups (P<0. 05) , which in midazolam group were lower than those in control group(P<0. 05). Plasma concentration of IL-10 in propofol group was higher than that in control and midazolam groups(P<0. 05), which was not significant different between midazolam group and control group. Conclusion Propofol sedation may attenuate the immunological depression during anesthesia and operation and attenuate the stress response.