不同剂量丙泊酚靶控输注对体外循环心脏手术患者血清中促炎细胞因子mRNA表达的影响

Effects of different target concentrations of propofol on pro-inflammatory cytokine mRNA expressions in patients underwent cardiopulmonary bypass surgery

目的:观察不同剂量丙泊酚对体外循环(CPB)心脏手术患者促炎细胞因子mRNA表达的影响,探讨丙泊酚的最适宜浓度并指导临床用药。方法:60例CPB心脏手术患者采用完全随机法分为3组(每组20例),麻醉诱导后给予丙泊酚血浆靶控输注(A组,2mg.L-1;B组,3mg.L-1;C组,4mg.L-1),并于诱导后(T0)、停CPB即刻(T1)、CPB后30min(T2)、60min(T3)和3h(T4)5个时间点抽取未抗凝静脉血8mL,用外周血淋巴细胞分离液进行梯度离心,从获得的淋巴细胞中提取RNA,逆转录合成cDNA,PCR后电泳扫描求积,检测细胞因子mRNA的水平。结果:CBP前3组患者血清细胞因子肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)及白细胞介素6(IL-6)水平比较,差异无统计学意义(P>0.05);CPB后3组患者血清TNF-α、IL-1及IL-6水平均升高,并在CPB后30～60min达到高峰,T1、T2、T3和T4组细胞因子水平与T0时比较明显升高(P<0.05)。B组和C组患者血清各细胞因子水平明显低于A组(P<0.05),而B组和C组间无明显差异。结论:丙泊酚能抑制CPB心脏手术患者血清促炎细胞因子IL-1、IL-6和TNF-α的释放,减少炎症反应,具有保护心肌的作用。应用丙泊酚实行CPB心脏手术的理想靶控浓度为3mg.L-1。

Objective To investigate the effects of different target concentrations of propofol on mRNA expressions of pro-inflammatory cytokines as interleukin-1（IL-1）,interleukin-6（IL-6） and tumor necrosis factor-α（TNF-α） in patients underwent cardiopulmonary bypass（CPB） surgery,and to explore the ideal concentration of propofol in Chinese people for clinical use.Methods Sixty patients underwent CPB were randomly assigned into three groups（n=20） according to the different target concentrations：group A,2 mg·L-1;group B,3 mg·L-1;group C,4 mg·L-1.The blood samples were taken at the time of induction（T1）,right after CPB（T2）,30 min after CPB（T3）,60 min after CPB（T4） and 3 h after CPB（T5）.The mRNA expressions of cytokines were detected by RT-PCR.Results The levels of the serum cytokine expressions of the patients in three groups showed no difference before CPB,while the levels of all cytokines rushed up after CPB and went up at peak between 30-60 min after CPB,which had great differences at T1,T2,T3 and T4 compared with T0.Compared with group A,the levels of all cytokines in group B and group C were significantly decreased（P0.05）.However,the expression levels of cytokines had no difference between group B and group C.Conclusion Propofol can inhibit the expressions of serum pro-inflammatory cytokines,including IL-1,IL-6 and TNF-α,in patients underwent CPB surgery;therefore inhibit inflammatory reaction.The recommended target concentration of propofol would be 3 mg·L-1 in CPB surgery.