星状神经节阻滞对体外循环术中皮质醇、TNF-α、IL-1β、IL-6的影响

Effect of stellate ganglion blocking on serum levels of Col,TNF-α,IL-1β and IL-6 in patients during cardiopulmonary bypass

目的探讨星状神经节阻滞后体外循环手术后患者炎症反应的影响。方法把我院心外科20例需进行二尖瓣置换的手术患者进行随机分组,分为对照组、星状神经节阻滞组(n=10)。对照组不予处理,星状神经节阻滞组予以1%利多卡因进行星状神经节阻滞。分别于术前20min,麻醉后20min,手术20min,体外循环20min,体外循环后20min取血标本,检测皮质醇、IL-1β、IL-6、TNF-α的血浆浓度。结果皮质醇在体外循环后20min时,星状神经节阻滞组(353.09±129.34)与对照组(486.84±152.20)有明显差异(P<0.05)。IL-1β、IL-6、TNF-α都有逐渐上升的趋势;星状神经节阻滞组[IL-1β(0.15±0.06)、IL-6(293.50±54.41)、TNF-α(2.37±0.52)]在体外循环后20min血浆浓度明显低于对照组[IL-1β(0.22±0.08)ng/ml,IL-6(341.17±43.06)ng/ml,TNF-α(2.92±0.57)ng/ml,P<0.05]。结论星状神经节阻滞可有效地减轻体外循环引起的炎症反应,其机制有待进一步探讨。

Objective To study the effect of stellate ganglion blocking （SGB） during cardiopulmonary bypass （CPB） on inflammatory reaction.Methods Twenty patients undergoing mitral valve replacement were randomly allocated to 2 matched groups,control group and SGB group （n=10）.The control group only received conventional anesthesia,while the SGB group was blocked with 1% lidocaine in addition before the operation for SBG.Blood glucose （BG）,Cortisol （Col）,IL-1β,IL-6 and TNF-α in the venous blood samples were detected in following 5 time points,20 min before anesthesia,20 min after anesthesia,20 min after operation,20 min afer the start of CPB and 20 min after the end of CPB.Results Col level of the control group （353.09±129.34 ng/ml） was significantly higher than that of the SGB group （486.84±152.20 ng/ml） in 20 min after the end of CPB （P〈0.05）.Serum levels of IL-1β,IL-6 and TNF-α had a trend of increasing.However,the serum levels of IL-1β [（0.15±0.06） ng/ml,IL-6 （293.50±54.41） pg/ml,TNF-α （2.37±0.52） ng/ml] in the SGB group were lower than those of the control group [IL-1β （0.22±0.08） ng/ml,IL-6（341.17±43.06） pg/ml,and TNF-α （2.92±0.57） ng/ml] in 20 min after the end of CPB （P〈0.05）.Conclusion SGB can relieve inflammatory reaction induced by CPB.