不同麻醉药物对围术期食管癌根治术患者血清中细胞因子水平及血液流变学的影响及临床意义

Effects of different anesthetics on levels of plasma cytokines and blood viscosity in perioperative esophageal cancer patients

目的探讨丙泊酚、安氟醚、异氟醚对围术期食管癌根治术患者血清中细胞因子白介素6(IL-6)和白介素10(IL-10)水平的影响以及患者血液流变学参数的变化特点,为临床麻醉合理用药提供理论依据。方法择期行食管癌手术患者45例(ASAⅠ、Ⅱ级),随机分为三组:丙泊酚组(A组),安氟醚组(B组),异氟醚(C组),每组15例,分别于诱导前(T0)、进胸后1 h(T1)及手术结束后24 h(T2),记录心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure,MAP),抽取外周静脉血,酶联免疫吸附法(ELASA法)检测血清中细胞因子IL-6、IL-10浓度,全自动血黏度仪检测低切变率下全血黏度。结果各组在不同手术期血流动力学参数未见显著差异;A组在T1、T2期,血清中IL-6的水平较B、C组低,IL-10的水平较B、C组高,差异均有统计学意义(P<0.05);T1期,A组低切变率下全血黏度较B、C组低(P<0.05)。结论麻醉药物丙泊酚在手术过程中能抑制促炎因子IL-6的分泌,促进抗炎因子IL-10的分泌,且对血液流变学指标影响小,是围术期较好的麻醉药。

Objective To study the perioperative changes of serum concentration of IL-6,IL-10 and the blood viscosity selected in perioperative esophageal cancer patients with Propofol,Enflurane and Isoflurane.Methods 45 ASA Ⅱ,Ⅲ patients scheduled for esophagus cancer surgery were randomly allocated to one of the three groups： Propofol group（group A）,Enflurane group（group B） and Isoflurane（group C）.3 groups were observed the HR,SBP,DBP,MAP changes at before induction（T0）,1 h after thomcotomy（T1）,and 24 h after operation（T2）.Blood samples were taken from internal jugular vein at T0,T1 and T2 for determination of serum IL-6,IL-10 and plasma viscosity.Results The HR,SBP,DBP,MAP of the 3 groups were not significantly different at all observation points（P 0.05）.All patients showed significant increases in IL-6 and IL-10 levels during T1 and T2.The concentration of IL-6 and blood viscosity in group A was lower than those of group B and C during T1 and T2（P 0.05）.The concentration of IL-10 in group A was higher than that of group B and C（P 0.05）.Conclusion Propofol can modulate the production of IL-6,IL-10 and blood viscosity,can acts as a better anesthetic.