硬膜外复合全身麻醉对老年人TNF-α、IL-6、CRP及尿Alb的影响

Effects of Combined General-Epidural Anesthesia on TNF-α,IL-6,CRP and Urinary Microprotein of the Aged Undergoing Upper Abdominal Operation

目的观察并比较硬膜外复合异丙酚静脉麻醉和异丙酚全凭静脉麻醉对老年人围手术期炎症反应及肾功能的影响。方法选择胃癌根治手术的老年患者30例,年龄(70.75±5.42)岁(65～81岁),随机分为异丙酚全凭静脉麻醉组(GA组)和硬膜外复合异丙酚静脉麻醉组(GEA组),每组15例。GA组麻醉以芬太尼0.2～0.4μg/kg、咪唑安定0.2mg/kg、维库溴铵4mg诱导行气管内插管,以异丙酚-芬太尼-维库溴铵维持麻醉。GEA组选择T8～T9行硬膜外穿刺,全麻的诱导与维持同GA组,诱导后硬膜外间断给予1%利多卡因+0.5%罗哌卡因4～6mL。分别于麻醉诱导前(T0)、手术开始后1h(T1)及术后第1天(T2)、第3天(T3)和第5天(T4)留取血、尿标本,测定血浆中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)和尿中的肌苷(Cr)、α1微球蛋白(α1-MG)、微量白蛋白(Alb)含量。结果两组患者静脉血TNF-α于T1时点显著高于T0时点(P<0.05);两组IL-6于T1～T4时点均较T0时显著升高(P<0.05);两组CRP于T2和T4时点较T0时显著升高(P<0.01),以上指标组间比较均无明显差别。T1～T4时点两组α1-MG/Cr均高于T0值(P<0.05),两组尿Alb/Cr于T1～T3时显著增加(P<0.05),组间比较GA组明显高于GEA组(P<0.05)。结论硬膜外复合全身麻醉并不抑制IL-6和CRP的分泌,但在一定程度上可减轻围术期肾功能的损伤。

Objective To observe the changes of cytokines and renal function in the elderly under- going upper abdominal operation provided with different approaches of anesthesia. Methods Thirty patients aged over 65yr （65-81yr） receiving radical gastrectomy for gastric cancer under general anesthesia were selected. They were divided into two groups, Group GA and Group GEA （15 in each）, and both induced with fentanyl 0.2-0.4 μg/kg, midazolam 0.2 mg/kg, and vacuronium 4 mg. The anesthesia in Group GA was maintained with propofol - fentanyl-vecuronium, and that in Group GEA with propofol- fentanyl-vecuronium and epidural anesthesia. Blood samples were analyzed for TNF-α, IL-6, CRP and urine for urinaryα1-mieroglobulin （α1-MG）, and albumin（Alb） before general anesthesia induction （T0）, 1 h after incision （T1）, on the first （T2）, third （T3） and fifth day （T4） postoperatively. Results Plas- ma TNF-α rose significantly on T1 and then returned to normal level with no difference between the two groups. Levels of circulating IL-6 in the two groups rose greatly after operation （P〈0. 01） without difference between the two groups. CRP increased significantly from T2 to T4 in both groups （P〈0.01）, and there was no difference between the two groups. Urinary α1-MG/Cr in both groups increased significantly from T1 to T4 （P〈0.05）, Alb/Cr from T1 to T3 （P〈0. 05） in the two groups, and the value in Group GA was significantly higher than that in Group GEA（P〈0.05）. Conclusion Combined general epidural anesthesia could not restrain the secretion of IL-6 and CRP, but would fairly lessen the damage of renal function occurring during and after operation in the elderly.