不同麻醉方法腹腔镜胆囊切除术对患者血清细胞因子的影响

Effects of different anesthesia techniques on serum IL-2, IL-6 and IL-10 in patients undergoing laparoscopic cholecystectomy

目的探讨不同麻醉方法对腹腔镜胆囊切除术围术期细胞因子IL-2、IL-6和IL-10的影响。方法60例择期行腹腔镜胆囊切除术患者，随机分为异丙酚全静脉麻醉（TIVA）组、静脉吸入复合麻醉（GA）组和硬膜外阻滞复合静脉吸入全麻组（GEA）组，每组20例，分别于麻醉诱导前（T0）、手术切皮时（T1）、CO2气腹建立后（T2）、术毕拔除气管导管时（T3）、术后1d（T4）采集外周静脉血，测定相应各时点血清IL-2、IL-6和IL-10浓度。结果与诱导前（T0）相比，各组IL-2在手术切皮时（T1）均明显下降（P〈0．01），切皮后TIVA组和GA组IL-2浓度逐渐升高，TIVA组与GA组IL-2浓度至术后24h（T4）时恢复至麻醉诱导前（T0）水平，而GEA组直到术后24h（T4）时IL-2浓度仍低于麻醉诱导前（T0）水平（P〈0．01）。各组IL-10浓度在手术切皮时明显增高（P〈0．01），TIVA组IL-10浓度至术毕拔除气管导管时达高峰，术后24h渐恢复正常，GA组及GEA组IL-10浓度在CO2气腹建立后渐恢复正常；GA组IL石浓度在术毕拔除气管导管时明显升高（P〈0．01），术后24h渐恢复至麻醉诱导前水平。结论芬太尼、异丙酚及维库溴胺行麻醉诱导可对患者产生免疫抑制，表现为IL-2浓度的下降；异丙酚全凭静脉麻醉可促进患者保护性免疫反应的产生；而硬膜外阻滞复合全麻能减轻腹腔镜胆囊切除手术对患者细胞因子的影响。

Objective To investigate the effects of different anesthesia techniques on serum IL-2,IL-6 and IL-10 in patients undergoing laparoscopic cholecystectomy. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing laparoscopic cholecystectomy were randomly divided into 3 groups with 20 cases in each group. All patients were premedicated with intramuscular atropine 0. 5mg and midazolam 3 rag. All patients were induced by propofol, fentanyl and vecuronium. Anesthesia injection was maintained with continuous infusions of propofol 6 - 10 mg · kg ^-1 · h^-1 in group TIVA. Group GEA （general-epidural anesthesia） was anesthetized by combined general-epidural anesthesia. Group GE was performed after general anesthesia. In GEA group, epidural anesthesia was performed at T7-8 interspace. The level of block was controlled in T4-12. HR, MAP and PET CO2 were continuously monitored. Blood samples （10 ml each）were taken from peripheral vein before induction of anesthesia（ T0 ） , at skin incision（ T1 ） , after pneumoperitoneum（ T2 ） , at extubation（ T3 ） and 24 - h postoperatively（ T4 ） for detecting serum levels of IL-2, IL-6 and IL-10. Results The concentration of serum IL-2 decreased significantly in three groups compared to base values （ P 〈0. 01 ） . In TIVA and GA groups, the concentrations of serum IL-2 recovered to pre-induction level gradually by 24-h postoperatively. But the serum IL-2 of group GEA was still lower. In GA group, the concentration of serum IL-6 increased significantly at T3, and it recovered to normal level at T4. In each group the IL-10 was significantly elevated at T1. The serum IL-10 of TIVA group increased to the peak level at T3 , then recovered to the normal value at T4, but it recovered to the normal standard gradually after T2 in group GA and GEA. Conclusion The perioperative cytokines response to laparoscopic cholecystectomy can be modified by the choice of anesthetics.