黄芪注射液对妇科腹腔镜手术患者围术期白细胞介素水平的影响

Effects of astragalus injection on perioperative interleukin level in patients with laparoscopic surgery

目的通过分析黄芪注射液对腹腔镜手术患者围术期白细胞介素的影响,初步探讨其对手术患者的免疫调节机制。方法 40例择期全麻下腹腔镜手术患者,年龄20～50岁,ASAⅠ～Ⅱ级,无血液病和免疫、内分泌系统等疾病,随机分成黄芪注射液组(A组)和对照组(C组)。A组静脉滴注黄芪注射液10 mL+生理盐水90 mL,15 min滴完后静脉注射芬太尼、丙泊酚、顺阿曲库铵行气管插管控制呼吸,术中以丙泊酚及七氟醚维持麻醉,维持生命体征在正常水平,术毕前腹腔冲洗液加入黄芪注射液10 mL,术毕待患者自主呼吸恢复,清醒后拔管。C组静脉滴注生理盐水100 mL后麻醉,腹腔冲洗液中不加黄芪注射液,余同A组。采集手术前(T0)、术毕(T1)、术后1 d(T2)、术后3 d(T3)的静脉血,ELISA测定白细胞介素(IL-2、IL-10)的水平,计算IL-2/IL-10比值。结果与T0时比较,C组IL-2水平及IL-2/IL-10比值在T1、T2时均明显下降(P<0.01),T3时才基本恢复T0时水平,A组在T1时下降(P<0.05),但T2时已恢复T0时水平;组间比较,两组IL-2水平T1、T2、T3时及IL-2/IL-10比值T1、T2时差异均有统计学意义,A组高于C组(P<0.05,P<0.01)。与T0时比较,两组IL-10水平在T1、T2、T3时均有所上升但差异无统计学意义,两组间各时点比较差异均无统计学意义(P>0.05)。结论黄芪注射液对腹腔镜手术有一定的免疫保护作用,可能是通过对辅助性细胞因子的正向调节作用实现的。

Objective To study the effects of astragalus on perioperative interleukin （IL） level in patients with laparoscopic surgery, thus to investigate the probable mechanism. Methods Forty patients with selected laparoscopic surgery, aging 20 - 50 years old, with American Society of Anesthesiologist （ASA）Ⅰ-Ⅱ and without hematogenic dis- ease, immune system disease or endocrine disease were enrolled. The participants were randomized into two groups, the astragalus group （Group A） and the control group （Group C）. Astragalus injection 10 mL ＋ physidogical saline 90 mL was given to patients in Group A 15 mins before anesthesia, also by mixed in the abdominal washing solution at the end of operation. The venous blood samples were collected before surgery （T0） and at 0 h （T1）, and on 1st day （T2）, and 3 day （T3） after surgery, for interleukins （ IL - 2, IL - 10） assessment by ELISA. Results Comparing with those at TO, significant reduction of IL - 2 and IL - 2/IL - 10 ratio were revealed at T1 and T2, but were recovered at T3 compared in Group C, while the reduction were revealed at T1 and recovered at T2 in Group A （P 〈 0. 05）. The IL - 2 levels were sig- nificantly higher in Group A than those in Group C at T1, T2 and T5 ; and so were the IL - 2/IL - 10 ratios at T1 and T2 （P 〈 0. 05 ）. No significant change in IL - 10 was revealed after anesthesia, neither the difference between the 2 groups. Conclusion The application of astragalus injection in laparoscopic surgery provides immune protective effects, via up - regulation of helper cytokines.