丙泊酚和异氟醚麻醉对舌癌围术期患者细胞因子反应的影响

Influence of propofol and isoflurane on cytokines response to cancer surgery during perioperative period

目的比较丙泊酚和异氟醚麻醉对舌鳞癌围术期患者炎性和抗炎性细胞因子反应的影响。方法选择24例拟行舌鳞癌根治手术的患者,随机分为丙泊酚组(P组)和异氟醚组(I组)。P组手术中麻醉维持采用丙泊酚5～8 mg.kg-1.h-1;I组麻醉维持采用异氟醚,维持呼气末浓度为体积分数0.6%。于麻醉诱导前(T0)、手术结束时(T1)、术后24 h(T2)和术后48 h(T3)分别采集外周静脉血,用酶联免疫吸附法检测血清白细胞介素(IL)-6和IL-10水平,并记录4个观测点的平均动脉压和直肠温度。结果两组患者T1、T2和T3时的IL-6、IL-10质量浓度均较术前明显增加(P<0.05),均于T1点达到峰值,术后24 h开始回落;I组IL-6质量浓度在T1点时高于P组(P<0.01),而IL-10质量浓度在T1、T2点时低于P组(P<0.05)。两组患者的平均动脉压和直肠温度在4个观测点均无统计学差异(P>0.05)。结论丙泊酚全静脉麻醉对舌癌根治术术后炎症反应比异氟醚轻,对预防严重并发症具有潜在的治疗意义。

Objective To compare the influence of propofol and isoflurane on pro-inflammatory and anti-inflam-matory cytokine response to perioperative period of tongue cancer surgery.Methods Twenty-four adult patients undergone the operation of tongue cancer were assigned to two groups randomly,propofol group（Group P） and isoflurane group（Group I）.In group P,anesthesia was induced with fentanyl 2-3 μg/kg,propofol 2 mg/kg,atracurium 0.6 mg/kg and maintained with propofol 5-8 mg·kg^-1·h^-1 and inhalation of 50% nirous oxide（N2O∶O2=50%∶50%）.In group I,anesthesia was induced with 3%-4% isoflurane,fentanyl 2-3 μg/kg,diazepam 0.06-0.1 mg/kg,atracurium 0.6 mg/kg and maintained with inhalation of 50% N2O and isoflurane（ended-tidal isoflurane was maintained at 0.6%）, in two groups atracurium was given intermittently.Blood samples were taken from peripheral vein before anesthesia（T0）,at the end of operation（T1）,24 h（T2） and 48 h（T3） after operation for determination of serum IL-6 and IL-10 concentrations.The mean arterial pressure（MAP） and body temperature in two groups were recorded. Results IL-6 and IL-10 levels increased significantly in two groups at T1,T2 and T3 compared with T0（P〈0.01）. The increasing trend of IL-6 and IL-10 levels were similar in both groups,whereas the level of IL-6 at T1 in propofol group was lower than that of isoflurane group significantly（P〈0.01）,however the level of IL-10 was much higher in propofol group than that of isoflurane group at T1 and T2（P〈0.05）.Conclusion The influence of total intravenous anesthesia of propofol on post-operation inflammatory response is much gentler than isoflurane.