利多卡因对腹腔镜结直肠癌根治术患者血清白细胞介素10和细胞角蛋白20的影响

The effect of lidocaine on perioperative levels of serum interleukin-10 and blood micrometastasis in colorectal cancer patients undergoing radical laparoscopic colorectectomy

目的 观察术中静脉输注利多卡因对腹腔镜结直肠癌根治术后血清白细胞介素（IL）-10和细胞角蛋白（CK）20的影响.方法 择期行腹腔镜结直肠癌根治术患者60例,年龄30～70岁,采用随机数字表法均分为利多卡因组（L组）和对照组（C组）,每组30例.麻醉诱导时L组以利多卡因首剂1 mg/kg静脉注射,继以利多卡因1.5 mg· kg-1·h-1持续泵注直至手术结束,C组持续输注等量生理盐水.于麻醉诱导前5min（T1）、手术结束即刻（T2）、术后24 h（T3）和48h（T4）从上臂外周静脉采集血液标本,采用ELISA法检测血清IL-10浓度;采用RT-PCR法检测CK20 mRNA.结果 T2～T4时两组患者血清IL-10浓度均明显高于T1时（P＜0.05）.T3时L组血清IL-10浓度明显低于C组（P＜0.05）.T1、T2、T4时两组患者血清IL-10浓度差异均无统计学意义.T1、T3时两组患者CK20 mRNA阳性表达率差异均无统计学意义.结论 利多卡因可降低腹腔镜结直肠癌根治术患者术后血清IL-10浓度,有利于减轻术后免疫抑制,但可能对术后癌细胞血行微转移无明显影响.

Objective To observe the effect of intravenous infusion lidocaine intraoperatively on serum interleukin （IL）-10 and the blood micrometastasis after radical laparoscopic colorectectomy. Methods Sixty hospitalized patients, aged 30-70 years, ASA I or II grade, Dukes stage A to C, scheduled to elective radical laparoscopic colorectectomy were equally randomized into two groups： lidocaine group （group L） and control group （group C）. Group L received intravenous injection lido caine 1 mg/kg at the beginning of anesthesia induction, then intravenous infusion lidocaine 1.5 mg· kg-1 · h-1 intraoperatively; group C received an equal volume of saline. Blood samples were taken from the peripheral venous at 5 rain before anesthesia induction （T1）, the end of surgery （T2）, postoperative 24 hours （T3） and 48 hours （T4）. The concentration of serum IL-10 was determined with an enzyme-linked immunosorbent assay （ELISA）. The positive expression rate of CK20 mRNA was determined with reverse transcriptase polymerase chain reaction. Results Compared with T1, the concentrations of serum IL-10 at T2-T4 in the two groups were significantly increased （P〈0. 05）. Compared with group C, the concentration of serum IL-10 in group L was lower at Ta （P〈0.05）. There was no significant difference of CK20 mRNA positive expression rate between the two groups at T1 and T3. Conclusion Intravenous injection lidocaine intraoperatively could reduce the postoperative immunosuppression after radical laparoscopic colorectectomy, and had no impact on the hematogenous micrometastasis at postoperative 24 hours.