咪达唑仑及芬太尼对骨折患者围手术期IL-6/IL-10影响

Effect of Midazolam or Fentanyl on Interleukin-6 and Interleukin-10 in Patients With Tibial and Fibular Fracture During Perio Perative Period

目的探讨胫腓骨骨折患者在腰硬联合麻醉下行切开复位内固定术时,使用咪达唑仑或芬太尼对血液中炎性因子平衡产生的影响。方法前瞻性研究399例,年龄20-70岁、美国麻醉师协会（ASA）Ⅰ-Ⅱ级胫腓骨闭合性骨折患者,随机分为对照组（C组）,咪达唑仑组（M组）和芬太尼组（F组）。3组患者均行腰硬联合麻醉,并于切皮前5 min静脉予2 ml等容量不同药液,切皮时重复给药。C组药液为生理盐水,M组药液为咪达唑仑0.04-0.05 mg/kg,F组药液为芬太尼1.5-2μg/kg。测定3组腰椎穿刺前5 min,切皮后5 min,缝皮结束时以及术后24-48 h血浆白细胞介素-6（IL-6）与白细胞介素-10（IL-10）的比值。结果 F组切皮后5 min IL-6/IL-10较腰椎穿刺前5 min升高,差异有统计学意义（P=0.013）。3组在缝皮结束时、术后24-48h IL-6/IL-10均较腰椎穿刺前升高,差异有统计学意义（P〈0.01）。缝皮结束时M组IL-6/IL-10较C组低,差异有统计学意义（P=0.009）。F组与C组比较差异无统计学意义。结论芬太尼静脉给药后可引起IL-6/IL-10一过性升高。小剂量咪达唑仑和芬太尼不能逆转创伤及手术造成的IL-6/IL-10升高。咪达唑仑有利于减轻创伤及手术造成的炎症反应。

Objective To investigate the effects of midazolam and fentanyl on the balance of plasma inflammatory factors in patients with tibial and fibular fracture undergoing open reduction and internal fixation with combined spinal-epidural anesthesia. Methods A prospective study of 399 patients with tibial and fibular fracture, aged 20 to 70 years old, USA society of nesthesiologists （ASA） grade I-II patients ,were randomly divided into control group （group C） ,midazolam group （group M） and fentanyl group （group F）. Patients in three groups were performed combined spinal-epidural anesthesia, and 2ml different liquid capacity was given intravenous at 5rain before skin incision,repeated when skin incision. 2ml normal saline was given in group C ,0.04 -0.05mg/kg midazolam was administrated in group M and 1.5 -2 μg/kg fentanyl was received in group F. Determine the ratio of plasma interleukin-6 （IL-6） and interleukin-10 （IL-10） 5 minutes before lumbar puncture ,5 minutes after skin incision,at the end of skin closure and 24 -48 hours after operation. Results The ratio of IL-6/ IL-10 increased significantly 5 minutes after skin incision in group F compared with that 5 minutes before lumbar puncture （P = 0. 013）. The ratio of IL-6/IL-10 increased significantly at the end of skin closure or 24 -48 hours after operation in all groups compared with that 5 minutes before lumbar puncture（ P 〈 0.01 ）. At the end of skin closure,the ratio of IL-6/IL- 10 was significantly decreased in group M compared with that in group C（P =0. 009）and there was no statistical significance between group F and group C. Conclusion Fentanyl can cause a transient increase in the ratio of IL-6/IL-10 by intravenous administration. A small dose of midazolam and fentanyl could not reverse the increased ratio of IL-6/IL-10 caused by trauma and operation. Midazolam is benifical to reduce inflammation caused by trauma and operation.