不同麻醉方法对大肠癌手术患者血浆IL-17和IL-23浓度的影响

IL-17 and IL-23 serum levels in patients undergoing colorectal cancer surgery: effects of different anesthetic techniques

目的:比较大肠癌手术中连续硬膜外复合静脉麻醉、全凭静脉麻醉和全凭吸入麻醉对患者血浆促炎性细胞因子IL-17和IL-23的影响。方法:2013年1月至2014年12月在本院接受择期大肠癌根治术的患者60例作为实验组,随机分成3组:连续硬膜外复合静脉麻醉组(A组,布比卡因连续硬膜外泵注维持麻醉,复合丙泊酚静脉泵注镇静)、全凭静脉麻醉组(B组,术中静脉泵注丙泊酚镇静,芬太尼镇痛)、全凭吸入麻醉组(C组,术中吸入笑气、氧气和七氟烷维持麻醉。对照组由健康体检者组成。ELISA法检测血浆细胞因子IL-17和IL-23浓度。结果:麻醉诱导前(T0)试验组患者血浆IL-17和IL-23浓度较对照组明显升高,试验组间差异无统计学意义(P>0.05);与T0时间点相比,手术开始后60 min(T1)、术后30 min(T2)和术后24 h(T3)试验组患者血浆IL-17和IL-23浓度明显降低,其中上述指标T1时明显低于T2和T3时,T2时明显低于T3时,差异均有统计学意义(P<0.05);与C组相比,T1、T2时间点A、B 2组患者血浆IL-17和IL-23浓度明显降低,且A组上述指标明显低于B组,差异有统计学意义(P<0.05);而在T3时间点试验组差异无统计学意义(P>0.05)。结论:3种麻醉方法均可明显抑制IL-17和IL-23释放,故对大肠癌有抑制作用,其中连续硬膜外复合静脉麻醉好于全凭静脉麻醉,全凭静脉麻醉好于全凭吸入麻醉。

Objective： To compare the effects of continuous epidural block combined with intravenous anesthesia, total intravenous anesthesia and total inhalational anesthesia on pro-inlfammatory cytokines IL-17 and IL-23 serum levels in patients undergoing colorectal cancer surgery.Methods： All patients were randomly divided into three trials groups （n=20）： continuous epidural block combined intravenous anesthesia group （A group）： patients received continuous epidural anesthesia of bupivacaine, and received intravenous anesthesia with propofol; total intravenous anesthesia group （B group）： patients received total intravenous anesthesia with propo-fol and fentanil; total inhalational anesthesia group （C group）： patients received total inhalational anesthesia with sevolfurane in O2 and Nitrous Oxide. Control group was composed of healthy subjects. Serum levels of IL-17 and IL-23 were quantiifed.Results： In three trials groups, levels of IL-17 and IL-23 were high prior to control group at induction of anesthesia （T0）, and there was no difference between three groups （P〉0.05）. Compared with T0, levels of IL-17 and IL-23 signiifcantly decreased at 60 min after the start of surgery （T1）, 30 min post-surgery （T2） and 24 h post-surgery （T3）; Levels of IL-17 and IL-23 were signiifcantly lower at T1 than T2 and T3, and they were signiifcantly lower at T2 than T3 （P〈0.05）. At T1 and T2, levels of IL-17 and IL-23 were signiifcantly lower in A group than that in B group, and they were signiifcantly lower in B group than C group （P〈0.05）; there was no difference between three trials groups at 24 h post-surgery （P〉0.05）.Conclusion： Three anesthetic tech-niques signiifcantly decreases IL-17 and IL-23 levels, so they has inhibiting effect on colorectal cancer. In this respect, continuous epidural block combined with intravenous anesthesia is better than the other two, total intra-venous anesthesia is better than total inhalational anesthesia.