摘要
目的 观察不同麻醉方法下实行开胸手术的肿瘤患者围手术期外周血清中可溶性白细胞介素－２受体（ＳＩＬ－２Ｒ）、白细胞介素－６（ＩＬ－６）和肿瘤坏死因子－α（ＴＮＦ－α）表达的动态变化，分析不同麻醉方法对患者免疫功能的影响。方法 选择 １２例食管、贲门癌患者分成二组，Ⅰ组吸入１％～２％异氟醚全麻＋２％利多卡因６～７ｍｌ／ｈ硬膜外阻滞，术后硬膜外０．１２５％布比卡因５～６ｍｌ／ｈ连续７２ｈ止痛；Ⅱ组静脉注入１～２ ｍｇ·ｋｇ－１·ｈ－１氯胺酮加连续硬膜外（药物及方法同Ⅰ组）维持麻醉，术后采用 ０．１％布比卡因＋０．０００３ ％芬太尼 ５～６ｍｌ／ｈ连续７２ｈ止痛。６例肺癌为Ⅲ组，麻醉同Ⅱ组，术后镇痛应用硬膜外连续注入０．１％氯胺酮 ４～５ｍｌ／ｈ。于麻醉前、切皮前、切皮后２ｈ及术后第１ｄ、第３ｄ、第5ｄ分别检测外周血清中ＳＩＬ－２Ｒ、ＩＬ－６和ＴＮＦ－α水平。结果 与麻醉前相比，麻醉后三组ＳＩＬ－２Ｒ、ＩＬ－６和 ＴＮＦ－α没有明显变化；切皮后 ２ｈⅠ、Ⅱ组ＳＩＬ－２Ｒ明显降低（Ｐ＜０．０５），Ⅲ组无明显变化（Ｐ＞０．０５），各组ＩＬ－６无明显变化，ＴＮＦ－α仅Ⅰ组明显下降（Ｐ＜０．０５）；术后第１ｄ血清中ＳＩＬ－２Ｒ明显上升?
Objective The aim of this study was to investigate the effects of different anesthetic drugs and techniques on serum SIL-2R, IL-6 and TNF-α in cancer patients undergoing elective thoracic surgery, trying to find a reasonable anesthesia for patients with compromised immune function. Methods Eighteen ASA Ⅰ-Ⅱ cancer patients(male 12, female 6) undergoing elective thoracic surgery were studied. The age ranged from 46-47 years. 6 patients suffered from lung cancer and 12 from cancer of esophagus or cardia. The patients received no radio-or chemotherapy before surgery. They were premedicated with intramuscular pethidine 50mg and atropine 0.5mg. Esophogus and cardia cancer patients were randomly divided into two groups: group Ⅱ and Ⅱ . Group Ⅲconsisted of only lung cancer patients. Group I received general anesthesia combined with continuous epidural block and postoperative epidural analgesia. An epidural catheter was inserted at T7-8 or T8.9 before general anesthesia. Anesthesia was induced with 2% thiopental sodium 5mg kg-1 and vecuronimn 0.06-0 .08mg kg-1 and maintained with 1%-2% isoflurane inhalation with epidural 2% lidocaine 6-7m1o h-1 . After operation epidural analgesia was produced with 0.125% bupivacaine 5-6ml h-1 for 72 h. In group Ⅱ the induction of general anesthesia was the same as in group Ⅰ , but anesthesia was maintained with ketamine infusion 1-2mg kg-1h-1 and epidural 2% lidocaine 6-7ml h-1. Postoperative analgesia was produced with epidural 0.1% bupivacaine + 0.0003% fentanyl 5-6m1o h-1 for 72 h. In group Ⅲ the induction and maintenance of anesthesia were the same as in group Ⅱ but postoperative analgesia was produced with epidural 0.1 % ketamine 4-5ml h-1. Blood samples were taken from peripheral vein before anesthesia, before and 2 h after skin incision and on the 1st, 3rd and 5th day after operation for determination of serum SIL-2R, IL-6 and TNF-α by ELISA(Genozyme Co) Results The serum SIL-2R, IL-6 and TNF-α levels were comparable before anesthesia and operation among the three groups. Serum SIL-2R decreased significantly at 2 h after skin incision(P < 0.05) in group Ⅰ and Ⅱ. Serum SIL-2R decreased at 2 h after skin incision in group Ⅲ but the decrease was not significant as compared with that before anesthesia. SIL-2R peaked on the 1st postoperative day in all groups then gradually decreased. There was no significant change in serum IL-6 and TNF-α during operation in the three groups. IL-6 and TNF-α increased significantly on the 1st postoperative day and then gradually deceased but there were no significant changes in IL-6 and TNF-α after operation in group 1 and Ill . Conclusions Both anesthesia and surgical trauma affect immune function. It seems that the effect of surgical trauma is more important. Intravenous ketamine seems to exert less effect on immune function and stress than inhalation anesthetic.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2001年第6期328-330,共3页
Chinese Journal of Anesthesiology
关键词
肿瘤坏死因子
肿瘤
全身麻醉
硬膜外麻醉
异氟烷
氯胺酮
胸外科手术
白细胞介素左受体
IL-6
Anesthesia, general
Anesthesia, epidural
Isoflurane
Ketamine
Thoracic surgical procedures
Receptors, interleukin-2
Interleukin6
Tumor necrosis factor
