芬太尼对心肺转流心脏手术围术期血浆炎性反应介质水平的影响

Effects of fentanyl on serum level of CRP and cytokines in patients undergoing cardiac surgery with cardiopulmonary bypass

目的 比较不同剂量芬太尼对心肺转流 (CPB)心脏手术患者围术期血浆C 反应蛋白(CRP)及肿瘤坏死因子 α(TNF α)、白细胞介素 8(IL 8)、白细胞介素 10 (IL 10 )水平的影响。方法 随机、双盲将择期心脏手术患者 2 4例分为两组 ,一组为芬太尼 0 0 2 5mg/kg组 (A组 ) ,另一组为芬太尼 0 0 1mg/kg组 (B组 ) ,每组 12例。分别于全麻诱导前 (基础 ,T0 )、主动脉开放后 (T1)、CPB停机后 (T2 )、术毕 (T3 )、术后 2 4h(T4)、术后 4 8h(T5)抽取患者中心静脉血 ,采用放射免疫法定量测定CRP、TNF α、IL 8和IL 10的血浆水平。结果 A组和B组TNF α在T0 、T1、T2 、T3 、T4、T5血浆浓度相比较无显著性差异 (P >0 0 5 )。CRP在T4时 ,A组高于B组 (P <0 0 5 )。IL 8血浆浓度在T0时A组值高于B组 (P <0 0 5 )。IL 10在T0 、T1,B组高于A组 (P <0 0 5 )。两组TNF α其他时点与T0 相比 ,无显著性差异 (P >0 0 5 )。CRP在两组中T4、T5与T0 相比均有显著升高 (P <0 0 5 )。IL 8在A组除T1外各个时点与T0 比均有显著升高 (P <0 0 5 ) ,在B组中除T5外各个时点值与T0 相比均有显著升高 (P <0 0 5 )。IL 10在A组中 ,各时点与T0 相比较均有显著升高 (P <0 0 5 ) ,而在B组中除T5外其他各时点血浆浓度值与T0 相比 。

Objective A comparison of the effects of different fentanyl doses on serum level of CRP, TNF-α, IL-8, and IL-10 in patients undergoing cardiac surgery.Methods Twenty-four patients scheduled for cardiac surgery with CPB were divided into two groups. Patients received a induction dose of 0.025 mg/kg of fentanyl followed by an intravenous infusion of 0.025 mg·kg -1·h -1 for maintenance of the general anesthesia in group A or 0.01 mg/kg of fentanyl for induction and 0.025 mg·kg -1·h -1 for maintenance in group B. The standardized anaesthetic also included vecuronium and midazolam. Blood samples for cytokines and CRP measurements were collected into EDTA-vacutainers from central vein at the following time points: just prior to induction of anesthesia (baseline, T 0), 5 min after aortic cross-clamp release (T 1), 5 min after weaning from CPB (end-CPB, T 2), on completion of surgery (T 3), 24 hours (T 4) and 48 hours (T 5) after the operation. The concentrations of CRP, TNF-α, IL-8, and IL-10 on blood serum were measured by radio immunoassay (RIA).Results Patients in group A had a significant increase in T 4,T 5 CRP, T 2-T 5 IL-8 and T 1-T 5 IL-10 (P< 0.05) and patients in group B had a significantly higher in T 4, T 5 CRP, T 1-T 5 IL-8 and T 5 IL-10 compared with the baseline (P< 0.05). The level of TNF-α at T 0-T 5 was not significantly different between group A and B. CRP at T 4 and IL-8 at T 0 were significantly higher in group A than that in group B. CRP at T 1 and IL-10 at T 2 were significantly lower in group A compared with that in group B. Conclusion A balanced anesthesia with fentanyl in an induction dose of 0.025 mg/kg followed by an intravenous infusion of 0.025 mg·kg -1·h -1 for maintenance of the general anesthesia offered advantage over 0.01 mg/kg of fentanyl for induction and 0.025 mg·kg -1·h -1 for maintenance on reducing systemic inflammatory response in patients undergoing cardiac surgery with CPB.