比较两种麻醉剂对胆道手术患者中性粒细胞凋亡、TNF-α、IL-6和IL-8的影响

Influence of Anesthetic Maintence with Intravenous Infusion of Propofol on the Apoptosis of Neutrophils and the Level of Cytokines in Sera of Patients with Biliary Surgery

探讨TNF α、IL 6、IL 8与异丙酚麻醉下胆道手术患者中性粒细胞凋亡的关系。ASAI～II级择期行胆道手术的非肿瘤患者 4 3例 ,随机分为异丙酚麻醉组 (P组 ,n =2 2 )及安氟醚麻醉组 (E组 ,n =2 1)。另选择健康成年人 16例作健康对照组。取手术前 (T1)、手术开始 (T2 )、手术开始后 3h (T3)、 2 4h (T4 )、 72h (T5 )外周静脉血 10ml,检测中性粒细胞凋亡及血浆细胞因子的水平。结果发现胆道手术患者术前中性粒细胞凋亡率明显低于健康对照组 ;同手术前比 ,T3、T4、T5时点中性粒细胞的凋亡率均明显降低 (P <0 0 1) ;而与E组比 ,P组分别在T3、T4时间点中性粒细胞凋亡率明显升高 (P <0 0 1)。胆道手术患者围术期血浆TNF α变化差异不明显 ;IL 6在手术创伤后升高 ,术后 1d达峰值 ,但在组间无明显的差异 ;围术期血浆IL 8的水平变化同IL 6 ,但与E组比 ,P组分别在T3、T4时间IL 8的血浆水平明显降低 (P <0 0 5、P <0 0 1)。本研究认为异丙酚麻醉与安氟醚麻醉相比 ,具有明显地减轻手术创伤后中性粒细胞凋亡的延迟作用 ,可能与异丙酚麻醉组创伤后细胞因子IL

To evaluate the effects and mechanism of anesthesia with propofol in regulating the apoptosis of neutrophils in patients with biliary surgery,43 cases of neoplastic ASA I or II patients undergoing elective biliary surgery were randomly allocated to the propofol (P) group and the enflurance (E) group with 16 healthy volunteers as the control group. Peripheral venous blood samples of patients before operation (T1),30 minutes after anesthesia and before skin incision (T2),3 hours after operation (T3),24 hours after operation (T4)and 72 hours after operation (T5) were taken,and the apoptosis of neutrophils was analyzed by means of Becjman Coulter flow cytometry and the plasma levels of TNF-α,IL-6 and IL-8 were measured by available ELISA kid. It was found that the percentage of spontaneous apoptosis of neutriphils in the P group was obviously higher than that of the E group at T3 and T4,but lower than that of the control group. In comparison with the initial values,there was no significant difference in the level of TNF-α between various groups.The plasma levels of IL-6 and IL-8 were increased in both groups at T3 and T4,but the level of IL-6 in P group was significantly lower than that of the E group. It concludes that intravenous infusion of propofol in comparison with anesthetic maintenance with inhaled enflurance can markedly relieve the delayed spontaneous apoptosis of neutrophils induced by surgical damages,that might be related with the release of IL-8 in enflurance group.