两种麻醉方式对腹腔镜手术患儿炎性细胞因子的影响

Effects of two anesthesia techniques on inflammatory cytokine in pediatric patients undergoing laparoscopic operation

目的比较两种麻醉方式对儿童腹腔镜手术炎性和抗炎性细胞因子反应的影响。方法1～3岁行腹腔镜手术的患儿40例，随机分为全麻组（GA组）和全麻复合硬膜外麻醉组（GEA组），每组20例。于麻醉诱导前（T0）、气腹5min（T1）、气腹30min（T2）、气腹结束后30min（T3）及气腹结束后24h（T4）取静脉血，ELISA法检测血浆IL-6、IL-8及IL-10浓度。结果两组IL-6水平T1、T2、T3时升高，T4时开始下降，与T0时比较差异有统计学意义（P〈0．05），组间比较差异无统计学意义（P〉0．05）。GA组血浆IL-8在T1～T4各时点升高，于T3达最高水平，与T0比较差异有统计学意义（P〈0．05）；GEA组T1～T4各时点与T0比较差异无统计学意义（P〉0．05）。两组间比较差异有统计学意义（P〈0．05）。两组IL-10水平在T1～T4均升高，与T0比较差异有统计学意义（P〈0．05）；GEA组较GA组T1～T4增高有统计学意义P〈0．05。结论全麻复合硬膜外阻滞能减轻腹腔镜手术对患儿炎性细胞因子的影响。

Objective To compare the influence of different anesthesia on inflammatory factors in pediatric patients undergoing laparoscopic. Methods Forty cases undergoing laparoscopie operation aged from 1 to 3 years （ASA grade Ⅰ -Ⅱ ） were divided into two groups randomly ： group GA, general anesthesia ; group GEA, combined general epidural anesthesia. Plasma IL-6, IL 8 and IL-10 were detected and recorded before anesthesia（T0 ）,5 min after pneumoperitoneum （T1）, 30 min after pneumoperitoneum （T2）, 30 min after operation（T3） and 24h after operation （T4）. Results Plasma IL-6 in T1, T2, T3 were higher than those in To, in both groups but no significant change between two groups （P〉0. 05）. Plasma IL-8 in group GA increased with time, and reached highest at 30 min after operation. Plasma IL-8 and TNF-α after pneumoperitoneum were higher than those at To in group GA,but no signif icant change in group GEA （P〉0.05）. Plasma IL-10 at T2 ,T3 ,T4 ,T4 were higher than those at To in both groups（P〈0.05）. Conclusion Combined general epidural anesthesia can restrain the level of inflammatory factors in pediatric patients undergoing laparoseopic operation.