两种复合麻醉对脊柱结核患者围术期白细胞介素6和10的影响

Effects of two different combined anesthesia strategies on perioperative interleukin-6 and interleukin-10 in patients with spinal tuberculosis

目的探讨两种麻醉方法对脊柱结核患者围术期IL-6和IL-10的影响。方法将40例行脊柱结核病灶清除术的患者随机分入丙泊酚组和异氟烷组,每组20例。丙泊酚组在气管插管后静脉持续注射丙泊酚5~12mg·kg^(-1)·h^(-1)维持麻醉;异氟烷组在气管插管后吸入异氟烷麻醉维持,维持呼气末异氟烷浓度为1.3~1.5最低肺泡有效浓度(MAC)。分别于麻醉前即刻(T_0)、切皮后2h(T_1)、停用麻醉药后即刻(T_2)、术后1h(T_3)、术后24h(T_4)各时间点,采集患者的中心静脉血,采用ELISA法测定血清IL-6、IL-10水平。记录患者的麻醉时间、术中输液量和芬太尼用量。结果两组间麻醉时间、术中补液量、芬太尼用量的差异均无统计学意义(P值均>0.05)。两组T_1时间点的血清IL-6和IL-10水平即明显升高,之后继续上升,丙泊酚组的血清IL-10水平至T_2时间点达峰值,两组的血清IL-6水平和异氟烷组的血清IL-10水平均至T_3时间点达峰值,T_4时间点有所回落,但仍维持在较高水平,两组T_1至T_4时间点的血清IL-6和IL-10水平均显著高于同组T_0时间点(P值均<0.01)。丙泊酚组T_2时间点的血清IL-6水平显著低于异氟烷组同时间点(P<0.05),T_2至T_4时间点的血清IL-10水平均显著高于异氟烷组同时间点(P值分别<0.05、0.01),两组间其他时间点血清IL-6和IL-10水平的差异均无统计学意义(P值均>0.05)。结论丙泊酚全凭静脉麻醉通过调节细胞因子IL-6与IL-10的平衡,减轻手术所致的应激反应,其效果优于异氟烷静吸复合麻醉。

Objective To investigate the effects of two different anesthetic methods on serum concentrations of interleukin-6 （IL-6） and interleukin-10 （IL-10） in patients with spinal tuberculosis. Methods Forty patients with spinal tuberculosis scheduled for focal cleaning were randomly divided into two groups （n = 20） ; propofol group and isoflurane group. After endotracheal tube intubation, propofol 5- 12 mg· kg-1 · h-1 was intravenously injected and isoflurane （1. 3 - 1. 5 fold minimum alveolar concentration） was inhaled for the maintenance of anesthesia in the two groups. Central venous blood samples were obtained at the following time points： before anesthesia （T0）, at 2 h after skin incision （T~）, immediately after anesthesia （T2）, at 1 h after surgery （T3） and 24 h after surgery （T4）. Serum concentration of IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay （ELISA）. The duration of anesthesia, intraoperative fluid volume and fentanyl consumption were recorded. Results There were no significant differences in terms of the duration of anesthesia, intraoperative fluid volume or fentanyl consumption between two groups （all P〉0.05）. The concentrations of IL-6 and IL-10 increased sharply in both groups at T1, the concentration of IL-10 in propofol group reached the peak at T2, and the concentrations of IL-6 in both groups an IL-10 in isoflurane group reached the peak at T3. The concentrations of IL-6 and IL-10 from T1 to T4 were significantly higher than those at To in both groups （all P〈 0.01）. The concentration of IL-6 at T2 in the propofol group was significantly lower than that in the isoflurane group （P〈0.05）, while the concentrations of IL-10 at T2, T3 and T4 in the propofol group were significantly higher than that in the isoflurane group （P〈0.05 or 0.01）. Conclusion Compared to isoflurane inhalation, total intravenouspropofol infusion can reduce perioperative stress reaction by adjusting the balance of cytokines.