术中物理降温时急性重症胆管炎手术病人围术期炎性反应的变化

Perioperative changes in systemic Inflammatory responses in patients undergoing physical cooling during the operation of acute severe cholangitis

目的评价急性重症胆管炎病人术中降温时围术期炎性反应的变化。方法12例急性重症胆管炎手术病人随机分为两组,每组6例。Ⅰ组未进行物理降温,Ⅱ组麻醉后进行物理降温, 保持术中体温36.7-37.3℃。于麻醉前(t1)、手术结束即刻(t2)、术后24 h(t3)采集静脉血,测定血清TNF-α,IL-6及IL-8的浓度。结果与Ⅰ组比较,Ⅱ组t1时中心体温、血清TNF-α、IL-6和IL-8浓度均无显著性变化(P>0.05),t2和t3时均降低(P<0.05)。两组t2和t3时中心体温、血清TNF-α、IL-6和IL-8 浓度较t1时降低(P<0.05)。结论急性重症胆管炎术中物理降温有助于减轻病人围术期的炎性反应。

Objective To evaluate the changes in systemic inflammatory responses in patients with physical cooling during operation of acute severe cholangitis. Methods Twelve patients with acute severe cholangitis, ASA Ⅱ-Ⅳ, beth sexes, aged 20-60 years, were randomly divided into two groups with 6 patients in each group, group Ⅰ received no physical cooling; group Ⅱ received physical cooling therapy after induction of anesthesia, and the core body temperature was decreased and maintained in 36.7-37.3℃ during operation. The intravenous blood samples were taken before anesthesia（t1 ）, at the end of operative procedures（t2 ） and 24 h after operation（t3 ） for the measurement of serum concentrations of TNF-α, IL-6 and IL-8.Results There were no significant differences in core temperature and serum levels of TNF-α, IL-6 and IL-8 at t1 between both groups（ P 〉0.05）. The core temperature, levels of TNF-α,IL-6 and IL-8 were lower at t2 and t3 in group Ⅱ than those in group Ⅰ （P 〈 0.05）. The core temperature, levels of TNF-α,IL-6 and IL-8 decreased significantly at t2 and t3 in both groups compared with those at t1 （ P 〈 0.05 ）. Conclusion The perioperative systemic inflammatory responses can be reduced in patients with physical cooling during operation of acute severe cholangitis.