摘要
目的:观察围术期硬膜外腔输注利多卡因对上腹部手术患者围术期血清细胞因子及皮质醇的影响。方法:36例择期上腹部手术患者,随机分为硬膜外麻醉+术后硬膜外腔注入利多卡因组(Ⅰ组,n=12),全麻+术后硬膜外腔注入利多卡因组(Ⅱ组,n=12)和全麻+术后硬膜外腔注入生理盐水组(Ⅲ组,n=12)。分别于术前0.5 h、术后0h、24 h和48 h抽取血样测定白细胞计数(WBC)、淋巴细胞计数(LC)及血清皮质醇、TNF-αI、L-6浓度。同时记录体温(T)、心率(HR)和平均动脉压(MAP)。结果:(1)各组病人体温、心率变化均不明显(P>0.05);平均动脉压变化:Ⅱ组术后0 h及Ⅲ组术后0 h2、4 h较术前明显增高;白细胞计数变化:3组患者白细胞计数术后0 h均较术前明显升高(P<0.01),Ⅱ、Ⅲ组较Ⅰ组亦明显升高(P<0.01),随后均下降,术后24hⅢ组明显高于Ⅱ组;淋巴细胞计数变化:3组患者淋巴细胞计数术后0h均较术前升高,其中Ⅱ、Ⅲ组明显高于Ⅰ组(P<0.05),术后24 h4、8 hⅢ组明显高于Ⅰ、Ⅱ组(P<0.01)。(2)3组患者皮质醇术后0h均较术前升高,其中Ⅱ、Ⅲ组明显高于Ⅰ组(P<0.05),术后24 h4、8 hⅢ组明显高于Ⅰ、Ⅱ组(P<0.01);3组TNF-α在各时点均逐渐上升,术后0 hⅡ组明显高于Ⅰ组,术后24 h4、8 hⅢ组明显高于Ⅰ组;3组IL-6水平术后0 h均为最高,其中Ⅰ组变化无统计学意义,Ⅱ、Ⅲ组明显高于术前。(3)皮质醇与IL-6呈正相关(r=0.818,P<0.01)。结论:围术期硬膜外腔输注利多卡因可有效抑制促炎细胞因子的释放,同时保护机体免疫功能,且两者之间有相关关系。
.Objective：To investigate the effects of perioperitive epidural lidocaine on serum cortisol and cytokines in the patients undergoing upper abdominal surgeries. Methods：Thirty-six patients undergoing elective upper abdominal surgeries were allocated randomly to epidural anesthesia＋ postoperative epidural lidocaine group（group Ⅰ ,n=12）,general anesthesia ＋ postoperative epi- dural lidocaine group（group Ⅱ ,n= 12） and general anesthesia＋ postoperative epidural NS group （group Ⅲ ,n=12）. Blood samples were taken at 0. 5 h before operation ,0 h,24 h and 48 h fol- lowing operation for determination of WBC,LBC, serum levels of cortisol ,TNF-α,and IL-6. At the same time, the T, HR and MAP were monitored. Results. （1）There were no significant statistic difference in T and HR of all patients（P〉0. 05）. MAP at 0 h after operation in group Ⅱ and 0 h, 24 h after operation in group Ⅱ were significantly higher than that at 0.5 h before operation. WBC and LBC at 0 h after operation were significantly higher than those at 0. 5 h before operation in all 3 groups, while those in group Ⅱ and Ⅲ were significantly higher than that in group Ⅰ , then they gradually decreased. At 24 h,48 h after operation those in group Ⅲ were significantly higher than those in group Ⅰ and Ⅱ. （2） Cortisol at 0 h after operation were significantly higher than those at 0. 5 h before operation in all 3 groups, those in group Ⅱ and Ⅲ were significantly higher than that in group Ⅰ , at 24 h,48 h after operation those in group m were significantly higher than those in group Ⅰ and Ⅱ ;TNF-α was gradually increased in all 3 groups,at 0 h after operation TNF-α in group Ⅱ was significantly higher than that in group Ⅰ , 24h ,48h after operation TNF-α in group Ⅲ were significantly higher than that in group I ;In group Ⅱ and Ⅲ, the serum concentrations of IL-6 Oh following operation were significantly higher than that 0.5 h before operation（P〈0.05）. （3）Cortisol was posttively correlated with IL-6. Conclusion：Perioperative epidural lidocaine can effectively inhibit the release of pro-inflammationary cytokine, and can improve the postoperative immune function. There may be some correlation between cortisol and cytokine production.
出处
《实用临床医学（江西）》
CAS
2006年第5期126-129,共4页
Practical Clinical Medicine
