不同麻醉方法对单核细胞mCD14与TLR4表达的影响

Effects of Different Anaesthesia Methods on Expression of Monocyte mCD14 and TLR4

目的:研究不同麻醉方法对外周血单核细胞mCD14与Toll样受体4(TLR4)表达的影响。方法:选择择期行结、直肠癌根治术患者,共24例,年龄18~65岁,性别不限;体质量指数(BMI)18~23kg/m2;美国麻醉医师学会(ASA)I^II级。所有患者分为2组:单纯全麻组(GA组)和全麻复合硬膜外阻滞组(GA+E组),每组各12例。GA组以6μg/kg芬太尼、1.5~2.0mg/kg丙泊酚和0.6~0.8mg/kg罗库溴铵行全麻诱导,术中以七氟醚维持麻醉,呼气末浓度维持在1.0~1.3最低肺泡有效浓度(MAC)。GA+E组患者入手术室后于T12~L1穿刺并放置硬膜外导管,全麻诱导方法和药物同GA组,气管插管后硬膜外分次给予1%利多卡因及0.2%丁卡因混合液共9~12mL,并维持呼气末七氟醚浓度在0.6~0.8MAC,术中每小时追加1%利多卡因及0.2%丁卡因混合液3~4mL。分别于手术前、手术开始(切皮)时、切皮后2h及术后24h采外周血测定单核细胞膜型CD14(mCD14)、Toll样受体4(Toll-like receptor4,TLR4)数值。结果:GA+E组和GA组相比,患者各时间点单核细胞mCD14数值均无显著变化。GA组手术开始时单核细胞TLR4较术前显著下降(P<0.05),而GA+E组各时间点单核细胞TLR4无显著变化。结论:硬膜外阻滞可能通过影响TLR4的表达平衡手术应激产生的免疫抑制。

Objective： This study was designed to investigate the effects of different anaesthesia methods on expression of monocyte mCD14 and TLR4. Methods： A total of 24 ASA Ⅰ or Ⅱ, BMI 18 23kg/m^2, 18 65 year old patients, who were scheduled for radical treatment of colon or rectum carcinoma were recruited in this study. They were randomly allocated to receive general anaesthesia （Group GA, n = 12） or general anaesthesia combined with epidural anaesthesia （Group GA ＋ E, n = 12）. Patients in Group GA were induced with 1.5-2.0 mg/kg propofol and 6μg/kg fentanyl, and tracheal intubation was accomplished with 0.6 0.8mg/kg rocuronium. The anaesthesia was maintained with sevoflurane （end tidal concentration 1.0- 1.3MAC）. Patients in Group GA ＋ E were placed an epi- dural catheter at a vertebral interspace between T12 and L1. General anaesthesia was performed as Group GA. After administration 1 lidocaine and 0.2% tetracaine %12ml, anaesthesia was maintained with sevoflurane, the end-tidal concentrations were 0.6 0.8 mininum alveolar concentration（MAC）, and epidural infusion of 1% lidocaine and 0.2%tetracaine 3-4ml/h. 2ml peripheral vein Blood was col- lected from every patient before operation, at the beginning of operation, 2 hours after the beginning of operation and 24 hours after the end of operation, respectively. Perioperative express of monocyte mCD14 and Toll-like receptor 4 were measured. Results： Compared with Group GA ＋ E, Group GA had no effects on the expression of monocyte mCD14 at different time points. Epidural anesthesia can prevent the depression of monocyte TLR4（P〈0.05）. Conclusions： Epidural anaesthesia may have benefitial effects on immune reaction and stress response induced by surgical stress.