不同麻醉方案对LC患者血浆TNF-α及IL-1β的影响  

Influence of Different Anesthetic Plans on the Concentration of Plasma TNF-α and IL-1β of the Patients Undergoing Laparoscopic Cholecystectomy

作　　者：彭庆明[1] 刘文捷[1] 李玉成[1] 郭立平[1] 

机构地区：[1]南华大学附属第一医院麻醉科,湖南衡阳421001

出　　处：《医学临床研究》2006年第9期1433-1435,共3页Journal of Clinical Research

摘　　要：目的 研究不同麻醉方案对LC患者血浆TNF-α及IL-1β的影响。 方法 120例ASAI～Ⅲ级择期行LC患者随机分为两组，全麻（G）组和全麻＋硬膜外麻醉（GE）组，每组各10例。G组给予芬太尼、异丙酚、卡肌宁诱导插管；GE组在T8～9，行硬膜外穿刺置管后行全麻插管，诱导药物剂量及麻醉机参数调节同G组。两组均给予丙泊酚微泵静推维持麻醉。分别于麻醉后切皮前（T1），腹腔充气后即刻（T2），腹腔充气后30min（T2），放气后10min（T4）及24h（T5）5个时点抽血检测TNF—α及IL-1β水平，同时记录各时点MAP、HR变化、各组麻醉药物用量、苏醒时间、麻醉费用及住院时间。 结果 除T1和T5外，G组其他时点MAP、HR较GE组显著增高（P〈0．05）；同时，除T1外，其他时点血浆TNF-α及IL-1β含量G组较GE组显著升高（P〈0．05）；两组T5时点的IL-1β值均较其T1时点降低，G组降低有显著性（P〈0．05）。GE组丙泊酚及芬太尼用量较G组明显减少（P〈0．05），且患者术后苏醒的时间较G组明显缩短（P〈0．05），且不增加患者麻醉费用及住院时间（P2〉0．05）。 结论 全麻插管＋硬膜外麻醉对于LC患者血浆TNF-α及TNF-1β含量影响较单纯全麻插管显著减轻，能减轻手术对患者免疫功能的影响，更适合于该类手术。[Objective]To investigate the influence of different anesthetic plans on the concentration of plasma TNF-α and IL-1β of the patients undergoing laparoscopic cholecystectomy （LC）. [Methods]Twenty adult ASA Ⅰ - Ⅲ patients scheduled for LC were randomly divided into general anesthesia group （Group G, n = 10） and general anesthesia combined with epidural anesthesia group （group GE, n = 10）. The patients in group G were induced with： fentanyl, propofol and atracurium. After epidural catheters inserted at T8-9 , the patients in group GE were induced with the same drugs as those in group G. Both groups were continually intravenously infused with propofol to maintain the anesthesia depth. The venous blood samples were drawn at the following time points： before operation （T1）, the moment of CO2 insufflated into peritoneal cavity （T2）, 30 minutes after CO2 insufflated （T3）, 10 minutes （T4） and 24 hours （Ts） after CO2 released to measure the concentration of plasma TNF-α and IL-1β. MAP and HR of each time point, the amount of the anesthetic agents used, the awake time and the expense of anesthesia and overal hospital stay were recorded. [Results] MAP and HR were significantly higher in group G than those in group GE, （ P 〈0.05）, except T1 and Ts. Compared with group GE, the concentration of plasma TNF-α and IL-1β was increased significantly in group G, （ P〈0.05）, except T1. The concentration of plasma IL-1β in Ts of both groups was decreased compared to T1, but the statistical difference was only found in group G. Less amount of fentanyl and propofol was used, the shorter awake time was in group GE （ P 〈0. 05）, while there was no difference in the expense of anesthesia and overall hospital duration in both groups （ P〉0.05）. [Conclusion]Compared with general anesthesia, there is less influence on the concentration of plasma TNF-α and IL-1β of the patients undergoing LC with general anesthesia combined with epidural anesthesia, so less influence to the p

关 键 词：外科手术 腹腔镜 肿瘤坏死因子/血液 白细胞介素-1/血液 麻醉 

分 类 号：R614[医药卫生—麻醉学]