大剂量芬太尼对心肺转流心脏手术血浆C反应蛋白及细胞因子的影响

Effects of high dose fentanyl on serum level of CRP and cytokines during and after cardiopulmonary bypass in man

目的 比较心肺转流 (CPB)下大剂量芬太尼 0 0 2 5mg/kg麻醉对成人和小儿血浆中C反应蛋白 (CRP)及促炎性反应因子肿瘤坏死因子α(tumornecrosisfactor α ,TNF α)、白细胞介数 8(IL 8)、白细胞介数 10 (IL 10 )水平的影响。方法 择期心内直视手术患者 12例分为两组 ,每组 6例。一组为小儿组 (A组 ) ,另一组为成人组 (B组 )。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 ,采用放射免疫方法定量测定CRP、TNF α、IL 8、IL 10血浆水平。结果 A组TNF α在T4血浆浓度高于B组 (P <0 0 5 )。CRP在T4、T5时 ,A组高于B组 (P <0 0 5 )。IL 8血浆浓度在T3 、T4时值A组高于B组 (P<0 0 5 )。IL 10在T3 时A组高于B组 (P <0 0 5 )。A组内TNF α在T1、T2 所测血浆浓度值和T0相比 ,有所降低 (P <0 0 5 ) ,余TNF α值变化不大 (P >0 0 5 )。CRP在A组和B组中T4、T5较T0 有明显升高 (P <0 0 5 )。IL 8在A组中T1、T3 和在B组中T3 、T4较T0 有显著升高 (P <0 0 5 )。IL 10在A组中 ,T3 、T4、T5和在B组中T4、T5血浆浓度值和T0 相比增高明显 (P <0 0 5 )。结论 CPB下行心脏手术时使用芬太尼 0 0 2 5mg/kg静脉麻醉 ,其调节?

Objective To compare the CRP and cytokine responses in adults and children undergoing cardiopulmonary bypass(CPB) with fentanyl 0.025 mg/kg infusion.Methods 6 children(group A)and 6 adults(group B)undergoing heart surgery under CPB were enrolled in this prospective study.Plasma levels of CRP,TNF-α,IL-8, and IL-10 were measured just prior to induction of anesthesia (baseline,T 0),at 5 min after aortic cross-clamp release(T 1),5 min after weaning from CPB(end-CPB,T 2),at end of surgery (T 3),24 h(T 4) and 48 h after operation(T 5).Results TNF-α at T 4 was higher in group A than that in group B. A significant increase of CRP at T 4 and T 5 was higher in group A than that in group B.IL-10 at T 3 and T 4 was higher in group A than that in group B.Compared with T 0,TNF-α was lower at T 1-2 in group A and the elevation of CRP was noted in both groups at T 4-5.IL-8 levels were significantly higher in group A at T 1、T 3 and in group B at T 3-4 than T 0 respectively.IL-10 levels increased in group A and B at T 3-5 and T 4-5 compared with T 0 respectively.Conclusions Fentanyl 0.025 mg/kg intravenous infusion in children undergoing cardiac surgery with CPB is associated with a more regulation of the systemic inflammatory responses than that in adults.