不同剂量丙泊酚靶控输注对体外循环心脏手术病人细胞因子TNF-α、IL-10mRNA表达的影响

Effects of different target concentration of propofol on cytokine TNF-α、IL-10mRNA expression in patients undergoing cardiopulmonary bypass surgery

目的观察不同剂量丙泊酚靶控输注对体外循环心脏手术病人细胞因子TNF-α、IL-10mRNA表达的影响,探索最佳的丙泊酚剂量,为其防治体外循环引起的心肌缺血再灌注损伤提供依据。方法选择拟行体外循环(CPB)的心脏手术成年患者60例,ASAⅡ～Ⅲ级,随机分为低剂量组(A组)2μg/ml,中剂量组(B组)3μg/ml,高剂量组(C组)4μg/ml,每组男、女各10例。利用RT-PCR法比较各组细胞因子TNF-α、IL-10mRNA的表达。结果停止体外循环后各时间点血清促炎性细胞因子TNF-αmRNA表达增强(P<0.05);血清抑炎性细胞因子IL-10mR-NA表达增强(P<0.05);停止CPB后T4、T5时间点中剂量组、高剂量组TNF-αmRNA的表达与低剂量组比较程度减弱(P<0.05);停止CPB后T4、T5时间点中剂量组IL-10mRNA的表达与低剂量组、高剂量组比较程度增强(P<0.05)。结论体外循环术中应用中剂量丙泊酚靶控输注与低剂量、高剂量相比更能够减轻炎症反应保护缺血再灌注心肌,值得在临床上应用和推广。

Objective The effect of different target concentration of propofol on mRNA expression of cytokines as tumor necrosis factor α（TNF-α） and interleukin 10（IL-10）in patients undergoing cardiopulmonary bypass（CPB） surgery.To investigate the best dose of propofol and provide the theory basis for preventing heart cells from myocardial ischemia-reperfusion injury.Methods Sixty adult patients undergoing CPB were assigned into three groups（n=20 each）,as the target concentration difference：low dose Group（A）-2 μg/ml,middle dose group（B）-3 μg/ml and high dose group（C）-4 μg/ml.Each group contains 10 males and 10 females.The mRNA expression of cytokines were detected by RT-PCA.Results The serum pro-inflammatory cytokine TNF-αmRNA expression enhancement at each time point after CPB（P0.05）,the serum anti-inflammatory cytokine IL-10 mRNA expression enhancement at each time point after CPB（P0.05）,the level of TNF-αmRNA expression at T4,T5 in middle and high dose group is obviously reduce compare with it in low dose group（P0.05）,the level of IL-10mRNA expression at T4,T5 in middle dose group is obviously enhance compare with it in low and high dose group（P0.05）.Conclusion The target concentration of propofol at middle dose（3 μg/ml） can inhibit inflammatory reaction and protect heart cells from myocardial ischemia-reperfusion injury during CPB compare with it in low and high dose group,the recommended target concentration of propofol would be 3μg/ml in CPB surgery.