七氟烷和丙泊酚麻醉对肺癌患者围术期细胞因子平衡的影响

The effect of sevoflurane inhalation anesthesia only and propofol total intravenous anesthesia on perioperative cytokine balance in lung cancer patients

目的:探讨七氟烷单纯吸入麻醉和丙泊酚全凭静脉麻醉对肺癌患者围术期细胞因子平衡的影响。方法:选择90例择期开胸行单纯性肺叶切除术的肺癌患者,随机分为两组:A组采用七氟烷单纯吸入麻醉;B组采用丙泊酚全凭静脉麻醉,每组45例。分别于麻醉诱导前即刻(T0)、单肺通气开始前即刻(T1)、单肺通气结束前即刻(T2)、手术关胸后即刻(T3)、术后24 h(T4)5个时间点抽取两组患者的静脉血,采用双抗夹心ELISA法测血清中细胞因子IL-6、IL-8、IL-10及TNF-α浓度。结果:(1)两组血清IL-6浓度在T1时均明显上升,与术前水平相比均有显著差异(P<0.05),T2及T3时IL-6水平继续升高,至T4时有所下降,但仍维持在一个较高的水平,与术前相比差异有统计学意义(P<0.05)。组间比较,B组T1和T2时IL-6浓度低于A组(P<0.05)。(2)两组血清IL-8浓度在T1、T2及T3时进行性上升,与术前水平相比均有显著差异(P<0.05)。T4时两组血清IL-8浓度较术中明显降低,但与术前比较仍有显著差异(P<0.05)。组间比较,B组在T1、T2及T3时IL-8浓度低于A组(P<0.05)。(3)两组血清IL-10浓度在T1时开始明显上升,与术前水平相比有显著差异(P<0.05)。T2及T3时IL-10水平继续升高,至T4时两组血清IL-10浓度较术后有所回落,但仍维持在较高水平。组间比较,B组T1到T4时IL-10浓度明显高于A组(P<0.05)。结论:丙泊酚全凭静脉麻醉可减轻肺癌患者围术期不良炎症反应,更有利于围术期细胞因子平衡的维持,其效果优于七氟烷单纯吸入麻醉。

AIM： To investigate the effects of sevoflurane inhalation anesthesia only and propofol total intravenous anesthesia on perioperative cytokine balance in lung cancer patients.METHODS： ASA I or II patients undergoing lobectomy for lung cancer were randomly divided into two groups with 45 cases each.In group A,patients received g sevoflurane inhalation anesthesia only and patients in group B received propofol total intravenous anesthesia.The cervical venous blood samples were obtained at the following time points： before induetion of anesthesia（T0）,before the start of one-lung ventilation（T1）,before the end of one-lung ventilation（T2）,after closed chest surgery（T3）,after 24 h（T4）.The serum concentrations of IL-6,IL-8 and IL-10 were measured by ELISA.RESULTS： ① In both groups the concentration of IL-6 increased at T1 and kept raising to a high level at T4 which showed significant differences with that of pre-operation（P〈0.05）.Compared between the groups,the concentration of IL-6 at T1 and T2 in group B was lower than that of group A（P〈0.05）.② In both groups the concentration of IL-8 kept at T1 and T3 which were significant with that of pre-operation（P〈0.01）.The concentration of IL-8 decreased apparantly at T4 in both groups,it was significant with that of pre-operation though（P〈0.01）.Compared between the groups,the concentration of IL-8 at T1,T2 and T3 in group B were all lower than that of group A（P〈0.05）.③ In both groups the concentration of IL-10 increased at T1 which was significant with that of pre-operation（P〈0.05）and kept at T2 and T3.It dropped somehow at T4 but still maintained at a high level.Compared between the groups,the concentration of IL-10 in group B at T1,T2,T3 and T4 was singicantly higher than that of group A（P〈0.05）.CONCLUSION： Propofol causes less inflammatory mediator release and can also modulate the balance of cytokines.It is a better anesthetic for lung cancer than sevoflurane.