骨水泥灌注对患者IL-6、TNF-α表达及循环功能的影响

Effects of calcium phosphate cement on expression of IL-6 and TNF-α and circulation in hip replacement surgery

目的观察人工全髋置换术(THR)中应用骨水泥对白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)表达及循环的影响。方法持续硬膜外麻醉下行THR患者12例,应用ELISA法检测术前、中、后血清IL-6及TNF-α表达水平,记录术前、骨水泥灌注即刻、灌注后3、5、10min时动脉BP,中心静脉压(CVP)以及血气参数。结果扩髓后、骨水泥灌注即刻,血清IL-6、TNF-α浓度与术前相比略有上调。术毕、术后24h,血清IL-6、TNF-α浓度比术前有显著升高(P<0.05)。骨水泥灌注即刻、灌注后3、5minBP显著下降(P<0.05)。骨水泥灌注即刻CVP明显下降(P<0.05),骨水泥灌注后3、5、10min时CVP均显著增加(P<0.05);部分患者偶见房早、室早、窦缓等心律失常。结论骨水泥灌注后,患者血清内IL-6、TNF-α浓度呈时间依赖性的表达增加,提示骨水泥灌注可能影响免疫应答反应。

Objective To study the effects of calcium phosphate eement（CPC） on expression of interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） and circulation in total hip replacement （THR） surgery. Methods The expressions of IL-6 and TNF-α were detected with EHSA in 12 patients undergoing THR under epidural blokade before and after CPC placement. BP, HR and central venous pressure（CVP） were recorded before and at 3,5,10 rain after CPC. Arterial blood gas analysis was performed as well. Results The expressions of IL-6 and TNF-α were significantly increased at the end of operation and 24 h after surgery compared to those before （P〈0.05）. BP was decreased at 3,5 min after CPC （P〈0.05）. CVP was remarkablly decreased immediately after CPC （P〈0.05）. Pao2 was remarkablly decreased soon after putting CPC （P〈0.05）. Atrial, ventricular premature beat or bradhycardia was seen in some cases after CPC. Conclusion The expressions of iL-6 and TNF-α are significantly increased time-dependently after CPC, suggesting that CPC may influence on immunoreaetion response.