AAI监测下不同麻醉镇静深度对肿瘤患者围术期炎性因子的影响

Effect of different sedation anesthesia depth to cytokines of tumor patient in perioperative period under auditory evoked potentials index monitor

目的:探讨不同镇静麻醉深度对肿瘤患者围术期炎性细胞因子的影响,为肿瘤患者选择适宜的麻醉深度,减少围术期炎症反应维护术后免疫力,保护患者免疫功能,提供依据。方法:选择2017年08月-2019年01月我院普外科择期行消化道肿瘤根治性切除患者66例,年龄34~88岁,体重40~95 kg,采用随机数字表法,将患者随机分为3组。应用听觉诱发电位指数(AAI)监测镇静麻醉深度,分为浅镇静麻醉组(AAI值在40-30范围内)、深镇静麻醉组(AAI值在29-20范围内)、传统麻醉组,根据血压、心率波动及制动、流泪、呛咳等指标及麻醉医师的经验调控镇静麻醉深度。分别于手术开始前即刻(T_(1))、手术开始后2 h(T_(2))、手术后24 h(T_(3))、手术后48 h(T 4)及72 h(T 5)时点检测患者血清白介素-2(IL-2)、白介素-4(IL-4)和肿瘤坏死因子(TNF-α)浓度。结果:组间比较,IL-2血浆浓度T_(1)时点浅麻醉组与传统组比较,浅麻醉组明显降低(P<0.05);T 4和T 5时点深麻醉组与传统组比较,深麻醉组明显降低(P<0.05),其余时点比较无统计学差异。IL-4血浆浓度比较,T_(2)和T 4时点浅麻醉组与传统组比较,浅麻醉组明显降低(P<0.05);T 4时点浅麻醉组与深麻醉组比较,深麻醉组明显升高(P<0.05)。TNF-α血浆浓度比较,T_(1)、T_(2)和T 4时点浅麻醉组与传统组比较,浅麻醉组明显降低(P<0.05),T_(1)时点浅麻醉组与深麻醉组比较,深麻醉组明显升高(P<0.05)。结论:浅镇静麻醉即AAI值在40-30范围比深镇静麻醉即AAI值在29-20时可以更好的保护肿瘤患者围术期Th 1细胞介导的细胞免疫功能,降低IL-4对细胞免疫的抑制作用,控制过度的炎症反应,保护患者免疫状态,帮助患者更好的康复。

Objective:To investigate the effect of different sedation anesthesia depth to tumor patients in perioperative inflammatory cytokines.Our clinical research provides the basis to choose an appropriate anesthesia depth for tumor patients,reduce perioperative inflammatory response maintaining postoperative immunity,prevention of tumor recurrence.Method:Application of auditory evoked potentials index(AAI)monitoring the sedation depth of anesthesia,divided into shallow sedation anesthesia group AAI values within the scope of the 40-30,deep sedation anesthesia group of AAI values within the scope of the 29-20,traditional anesthesia group,according to the blood pressure,heart rate fluctuations and brake,tears,choking cough and other indicators and the experience of the anesthesiologist control anesthesia depth.Choosing five time point detecting the concentration of serum IL-2,IL-4,TNF-αof patient:T_(1)-Immediately before the beginning of the next surgery,T_(2)-2 h after start the surgery,T_(3)-24 h after surgery,T 4-48 h and T 5-72 h after surgery.Results:Comparison between groups,IL-2 plasma concentration of T_(1)point shallow anesthesia group compared with the traditional group,the shallow anesthesia group significantly decreased(P<0.05),T 4 and T 5 points deeper anesthesia group compared with the traditional group decreased obviously(P<0.05).Compared IL-4 plasma concentration of groups,T_(2)and T 4 points the shallow group significantly decreased compare with the traditional group(P<0.05).Plasma concentration of TNF-α,T_(1),T_(2)and T 4 points the shallow anesthesia group significantly decreased than the traditional group(P<0.05),T_(1)point the shallow anesthesia group compared with deeper group decreased significantly(P<0.05).Conclusion:Compare with deep sedation anesthesia(AAI 29-20),shallow sedation anesthesia(AAI 40-30)might more benefit to tumor patients which improve Th 1 cell-mediated cellular immune function in perioperative,reducing the inhibition of cellular immunity and IL-4 control excessive inflammation,helping patients better recovery,reducing tumor recurrence.