高容量血液稀释对下肢缺血-再灌注患者外周血IL-6、IL-10表达的影响

Effects of preoperative acute hypervolemic hemodilution on expressions of IL-6 and IL-10 in patients undergoing ischemia-reperfusion of lower extremity

目的 观察术前急性高容量血液稀释（AHH）对下肢缺血-再灌注（I-R）患者外周血白细胞介素-6（IL-6）、白细胞介素-10（IL-10）及其mRNA表达的影响.方法 硬膜外麻醉下使用止血带的单侧下肢择期手术患者24例,随机分为6%羟乙基淀粉组（HES,H组）和复方乳酸钠组（R组）,每组12例.切皮前30 min,H组患者输入HES 130/0.4 15 ml/kg,R组给予复方乳酸钠.分别于术前（T1）、松止血带后30 min（T2）、4 h（T3）取静脉血检测IL-6和IL-10及其mRNA表达.结果 与R组比较,T2、T3时H组血浆IL-6浓度和IL-6 mRNA、IL-6/IL-10比值及IL-6 mRNA/IL-10 mRNA明显降低（P〈0.05）;而血浆IL-10浓度和IL-10 mRNA明显升高（P〈0.05）.结论 术前应用HES130/0.4行AHH可抑制促炎性细胞因子生成的同时,还可促进抗炎性细胞因子产生,能有效维持促炎性细胞因子和抗炎性细胞因子平衡.

Objective To investigate the effects of preoperative acute hypervolemic hemodilution （AHH） on the expressions of interleukin-6（IL-6）, IL-10 and their mRNA in patients undergoing ischemia- reperfusion（I-R） injury of lower extrremities. Methods Twenty-four patients undergoing operation of single lower extrremity with tourniquet were randomly divided into two groups with 12 cases each. The patients in group H were infused hydroxyethyl starch（HES） 15 ml/kg 30 minutes before skin incision, and those in group R with sodium lactated Ringers solution instead of HES. Blood samples were taken before skin incision （T1）, at 30 min（T2 ）, 4 h（T3 ） after toumiquet deflation for determination of expressions of plasma IL-6, IL- 10 and their mRNA. Resdts IL-6 level, IL-6/IL-10 ratio and IL-6 mRNA/IL-10 mRNA ratio at T2 ,T3 were all lower in group H than those in group R（P〈0. 05）. The expressions of IL-10 and its mRNA were significantly higher in group H than those in group R（P〈0. 05）. Conclusion AHH with HES is effective in maintaining a balance between pro-and anti-inflammatory cytokines.