非心肺转流冠脉搭桥围术期IL-2和IL-4的变化

Changes of interleukin-2 and interleukin-4 in patients undergoing off-pump coronary artery bypass under general anesthesia

目的 研究两种复合全麻下 ,非心肺转流冠脉搭桥 (OPCAB)围术期辅助性T淋巴细胞的免疫应激反应。方法 2 4例患者随机分入丙泊酚 芬太尼全凭静脉麻醉组 (P组 )和异氟醚 芬太尼静吸复合麻醉组 (I组 ) ,于诱导前、术中打开心包和旁路血管开放时及术后 2h采集血标本 ,应用放免法检测血清白细胞介素 2 (IL 2 )和白细胞介素 4 (IL 4 )的含量。结果 IL 2两组均减少 ,P组术中、术后均较诱导前有非常显著性降低 (P <0 0 1) ,I组打开心包时降低明显 (P <0 0 5 ) ,旁路血管开放时降低更显著 (P <0 0 1)。两组相比 ,I组IL 2于旁路血管开放时比P组下降更明显 (P <0 0 1)。旁路血管开放时 ,P组IL 4明显高于I组 (P <0 0 5 )。结论 丙泊酚 芬太尼静脉麻醉行OPCAB术对抑制免疫应激反应有益 。

Objective To investigate the immune stress response of helper T lymphocyte (Th) to the off pump coronary artery bypass (OPCAB) under two general anesthesia methods.Methods Twenty four patients scheduled for elective OPCAB were randomly allocated to one of two groups:total intravenous anesthesia (group P)and isoflurane with fentanyl (group I).Arterial blood samples were collected before induction of anesthesia,at dissecting pericadia,opening bypass vessel,2hours after operation.Serum concentrations of interleukin 2 (IL 2) and interleukin 4(IL 4)were measured by radioimmunoassay.Results There was significantly decreased during and after operation compared with at before in IL 2 concentrations between tow groups ( P< 0 01),dissecting pericadiac and opening bypass vessel and 2 hours which was depressed more significantly in group I than in group P at opening bypass vessel( P< 0 01).Compared with group P,there was a significantly decrease in group I at opening bypass vessel ( P< 0 01).IL 4 was significantly higher in group P than that in group I at opening bypass vessel ( P< 0 05).Conclusions Total intravenous anesthesia with propofol could inhibit the immune reaction of Th lymphocyte to OPCAB more than isoflurane inhalation with fentanyl.