不同麻醉药对体外循环细胞因子的影响

Effects of different anesthetics on cytokines induced by cardiopulmonary bypass

目的 观察不同麻醉药对体外循环 (CPB)炎性反应的影响。方法 45例先天性心脏病房、室间隔缺损患者 ,按麻醉维持不同随机分为 3组 :芬太尼组 (Fen组 )主要用芬太尼维持 ;异氟醚组 (Iso组 )以吸入体积分数为 1 0 %～ 1 5 %异氟醚为主 ;异丙酚组 (Pro组 )主要用异丙酚维持。分别于以下 5个时点采集动脉血 ,麻醉诱导后 (T1)、切皮前 (T2 )、升主动脉开放后(T3 )、CPB术后 2h(T4)、CPB术后 2 4h(T5 ) ,用放射免疫法测定肿瘤坏死因子 -α(TNF -α)、白介素 - 6(IL - 6)。结果 Iso组切皮前 (T2 )TNF -α明显下降 ,从 0 94μg/L降至 0 3 8μg/L ,有极显著性差异 (P <0 0 1) ;T2～T4的值明显低于其他两组(P <0 0 5 )。各组TNF -α、IL - 6在CPB中及术后均较切皮前 (T2 )升高 (P <0 0 5或P <0 0 1)。三组间各时间点IL - 6的差异无显著性 (P >0 0 5 )。结论 CPB过程中及术后血浆TNF -α、IL - 6均有不同程度升高 ,最高值在CPB术后 2h出现 ,于术后 2 4h降低 ,但仍高于术前水平。异氟醚对TNF -α的释放虽有一定的抑制作用 ,但并不能改变CPB手术对TNF -α的影响 ;而异氟醚、芬太尼和异丙酚对IL -

Objective To observe the effects of different anesthetics on the inflammatory response induced by cardiopulmonary bypass (CPB). Methods Forty five patients who underwent surgical correction of congenital heart defects were randomly allocated into three groups according to different anesthetic maintenance:i.e. maintenance with fentanyl(group Fen),with isoflurane(group Iso),and with propofol(group Pro) Plasma levels of tumor necrosis factor alpha(TNF α) and interleukin 6(IL 6) were measured by radioimmunoassayat following points:after anesthetic induction(T1),before incision(T2),after aorticunclamping(T3),at h 2 after weaning from CPB and at h 24 after surgery. Results The plasma level of TNF α significantly decreased from 0 94 μg/L to0 38μg/Lbeforeincision(T2)ingroupIso( P <0 01) TherewaslowerlevelatT2～T4ingroupIsothaninothertwogroups ( P <0 05) The plasma levels of TNF α and IL 6 increased during and after CPB in all groups compared with T2( P <0 05 or P <0 01) But there was no significant difference in the levelsofIL 6 in three groups( P >0 05). Conclusion The surgical procedure withCPB induces the increase of cytokines TNF α and IL 6 The peak appears at postoperative 2 h Inhalation of isoflurane inhibits the release of TNF α,but it does notchange the effect of the surgical procedure with CPB There is no significantdifference in the effect of isoflurane ,fentanyl and propofol on IL 6.