丙泊酚或七氟醚复合瑞芬太尼对食管癌根治术患者单肺通气时中性粒细胞NF—κB活性的影响

Effects of propofol versus sevoflurane combined with remifentanil anesthesia on activity of nuclear factor- kappa B in neutropbii granulocyte during one-lung ventilation in patients undergoing radical resection of esophagus cancer

目的比较丙泊酚或七氟醚复合瑞芬太尼对食管癌根治术患者单肺通气时中性粒细胞NF-κB活性的影响。方法择期全麻单肺通气下行左侧开胸食管癌根治术患者40例，年龄40～64岁，性别不限，体重指数18-25kg／m2，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将其分为2组（n=20）：丙泊酚．瑞芬太尼组（P组）和七氟醚-瑞芬太尼组（S组）。麻醉诱导后气管插管并机械通气，麻醉维持：P组静脉输注丙泊酚4-8mg·kg-1·min-1，S组吸入1％～3％七氟醚，2组均静脉输注瑞芬太尼0．2μg·kg-1·min-1，维持Narcotrend指数值40～50，间断静脉注射顺苯磺酸阿曲库铵7mg维持肌松。分别于气管插管后5min、单肺通气开始即刻、30、60、90min、恢复双肺通气即刻、恢复双肺通气后10min及术毕时采集桡动脉血样，进行血气分析，计算氧合指数和呼吸指数，测定血浆IL-1浓度，提取中性粒细胞核蛋白，测定中性粒细胞NF-κBDNA结合活性。结果与P组比较，s组呼吸指数、血浆IL-1浓度和中性粒细胞NF-κBDNA结合活性升高（P〈0．05），氧合指数差异无统计学意义（P〉0．05）。结论与七氟醚．瑞芬太尼麻醉比较，丙泊酚一瑞芬太尼麻醉可抑制食管癌根治术患者单肺通气时中性粒细胞NF-κB激活，有助于减轻肺组织炎性反应。

Objective To compare the effects of propofol versus sevofiurane combined with remifentanil anesthesia on the activity of nuclear factor-kappa B （NF-κB） in neutrophil granulocyte during one-lung ventilation （OLV） in patients undergoing radical resection of esophagus cancer. Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes, aged 40-64 yr, with body mass index 18-25 kg/m2 , undergoing radical resection of esopha- gus cancer, were randomized into 2 groups （ n = 20 each） ： propofol-remifentanil group （group P） and sevofiurane- remifentanil group （group S）. Anesthesia was induced with midazolam, sufentanil, etomidate and cisatracurium besylate in both groups. The patients were tracheal intubated and mechanically ventilated. Anesthesia was main- tained with iv infusion of propofol 4-8 mg. kg-1 . min-1 in group P, or with inhalation of 1%-3% sevoflurane in group S, and with iv infusion of remifentanil 0.2μg. kg- 1 .min-1 and intermittent iv boluses of cisatracurium besy- late 7 mg in both groups. The Narcotrend index value was maintained between 40 and 50. Blood samples were tak- en from the radial artery at 5 rain after intubation, the beginning of OLV, 30, 60 and 90 min of OLV, 0 and 10 min after re-expansion of the collapsed lung, and the end of surgery for blood gas analysis and for determination ofplasma concentrations of IL-1. The oxygenation index and respiratory index were calculated. The nuclear protein of neutrophil granulocytes was extracted tor detection of NF-κB-DNA binding activity.Results Compared with group P, the respiratory index, plasma concentrations of IL-1 and NF-κB-DNA binding activity were signilicantly in- creased （ P 〈 0. 05）, and no significant change was iound in the oxygenation index in group S （ P 〉 0. 05）. Con- clusion Compared with sevoflurane-remifentanil anesthesia, propofol-remifentanil anesthesia can inhibit activation of NF-κB in neutrophil granulocyte and is helpful in attenuating the inflammatory response in lung tissues during OLV in patients undergoing radical reseclion of esophagus cancer.