术前口服酮洛酸和可乐定对上腹部手术患者细胞因子反应的影响

Influnce of oral clonidine and ketorolac premedication on cytokine response to abdominal surgery

目的 评价术前止痛对上腹部手术病人围手术期细胞因子反应的影响。方法 选择2 0例拟于全麻下行全胃或胃次全切除的患者 ,单盲随机分成两组。 (1)术前止痛组 :术前 1h口服酮洛酸 10mg和可乐定 4μg/kg ;(2 )对照组 :术前 1h口服等量安慰剂。分别于术前 2 4h、全麻诱导后2 0min(术前 )、诱导后 90min(术中 )、术后 0、1、2、4、6和 2 4h测定患者血清TNF α、IL 1β、IL 6和IL 10的水平。结果 (1)术前止痛组血清IL 6的水平于术后 0h有显著上升 ,术后 4h达高峰 ,而对照组于诱导后 90min(术中 )即有显著上升 ,术后 2h达高峰 ;两组IL 6的水平于术后 0、1、2h有显著性差异(P <0 0 1) ,且术前止痛组的峰值显著低于对照组 (P <0 0 5 )。 (2 )两组TNF α及IL 10的水平均于术中即有显著上升 ,术后 2h达高峰 ,但两组TNF α和IL 10的水平无显著性差异 (P >0 0 5 )。 (3)两组IL 1β的浓度在围手术期处于较低的水平 ,无统计学意义。 结论 (1)术前口服酮洛酸和可乐定在一定程度上降低了术后患者促炎症因子IL 6的水平 ,对防止严重并发症的发生 ,具有潜在的治疗意义 ;(2 )创伤后促炎症因子IL 6、TNF

Objective The aim of the study was to examine the influence of clonidine and ketorolac pretreatment on cytokine response to abdominal surgery. Methods Twenty patients scheduled for upper-abdominal surgery were randomly allocated to two equal groups: (1) pre-emptive analgesia group: patients received oral clonidine 4μg/kg and ketorolac 10mg 1h before surgery and (2) control group: patients received placebo. Blood samples were taken 24h before surgery , 20min after induction of anesthesia (before surgery), 90min after induction (during surgery), and 0,1,2,4,6 and 24h after surgery for determination of serum tumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β),interleukin-6(IL-6) and interleukin-10 (IL-10) concentrations.Results (1) In the control group, serum IL-6 concentration increased significantly during surgery and peaked at 2h after skin closure. In contrast serum IL-6 concentration in pre-emptive analgesia group increased significantly when the skin was closed and peaked at 4h after skin closure. IL-6 production in the pre-emptive analgesia group was less than that in control group at 0,1 and 2h after surgery(P<0.01). Therefore the IL-6 response was delayed and attenuated in the pre-emptive analgesia group.(2) The TNF-α and IL-10 responses to surgery were comparable between the two groups. (3) IL-1β concentration was low and there was no significant change in concentration throughout perioperative period in either group.Conclusions Premedication with clonidine and ketorolac reduces proinflammatory cytokine response, and may have therapeutic potential. The increase in proinflammatory cytokines (IL-6,TNF-α) may activate endogenous anti-inflammatory mechanism.