高乌甲素对患者围术期免疫功能的影响  

Effects of Iappaconitine on perioperative immune function

作　　者：苏帆[1] 魏涛[1] 姚尚龙[2] 

机构地区：[1]山东中医药大学附属医院麻醉科,济南市250011 [2]华中科技大学同济医学院附属协和医院麻醉科

出　　处：《中华麻醉学杂志》2008年第7期615-618,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨高乌甲素对患者围术期免疫功能的影响。方法择期行乳腺癌根治术、椎管狭窄椎板切除减压术、人工股骨头置换术患者各8例，随机分为2组（n=12）：对照组（C组）和高乌甲素组（L组）。L组麻醉诱导前30min经30min静脉输注高乌甲素8mg，静脉注射恩丹西酮4mg；C组给予等容量生理盐水。2组采用异丙酚、瑞芬太尼和罗库溴铵进行麻醉诱导和维持。诱导开始后L组持续背景输注0．28mg／ml高乌甲素2ml／h。术毕待患者清醒后，L组采用0．28mg／ml高乌甲素行病人自控镇痛（PCA），背景输注速率2ml／h，PCA剂量0．5ml，锁定时间15min。C组术后镇痛采用按需单次肌肉注射哌替啶50mg和氟哌利多2．5mg。于麻醉诱导前30min（T1）、术毕（T2）、术后24h（T3）和48h（T4）时采集外周静脉血样，采用ELISA法测定TNF-α、IL-2、IFN-7和sIL-6R浓度；采用流式细胞仪测定CD3、CD4、CD8和NK细胞表达，计算CD4／CD8；采用放射免疫法测定IgA、IgM、1843、C3和C4浓度。结果与C组比较，L组T2-4时sIL-6R浓度降低，L3-4时TNF-α浓度降低，IL-2和IgA浓度升高，T2-3，时IgG浓度升高，T3时IgM浓度和CD4／CD8升高（P〈0．05或0．01）。结论高乌甲素可改善患者围术期体液免疫功能，可能与其镇痛和抗炎作用有关。Objective To investigate the effects of lappaconitine on the perioperative immune function. Methods Twenty-four ASA Ⅰ or Ⅱ patients aged 23-64 yr undergoing elective radical mastectomy （8 patients）, laminectomy and vertebral canal decompression （8 patients） or femoral head replacement （8 patients） were randomly divided into 2 groups （n = 12 each）： control group （C） and lappaconitine group （L）. In group L ondansetron 4 mg was given IV and lappaconitine 8 mg was infused Ⅳ over 30 min before induction of anesthesia. In group C equal volume of normal saline was infused instead of lappaconitine. Anesthesia was induced and maintained with propofol, remifentanil and rocuronium. Lappaconitine 0.28 mg/ml was continuously infused at 2 ml/h after induction of anesthesia in group L. When the patients recovered from anesthesia after operation, PCA with 0.28 mg/ml lappaconitine was started （background infusion 2 ml/h, bolus dose 0.5 ml and lockout interval 15 min）. In group C pethidine 50 mg and droperidol 2.5 mg were given IM on demand. Venous blood samples were taken at 30 min before induction of anesthesia （T1 , baseline）, immediately （T2） and at 24 h （T3 ） and 48 h （T4） after operation for determination of TNF-α, IL-2, IFN-7 and sIL-6R concentration by ELISA. CD3, CD4, CD8 and NK cell expression was determined using flow cytometry and the ratio of CD4/CD8 was calculated. The concentrations of IgA, IgM, IgG, CD3 and CD4 were determined by radioimmunoassay. Results Plasma sIL-6R and TNF-α concentrations were significantly lower while IL-2, IgA, IgG, IgM concentrations and CD4/CD8 ratio were significantly higher after operation in group L than in group C. Conclusion Lappaconitine can improve perioperative humoral immune function thus contributing to its analgesic and anti-inflammatory effects.

关 键 词：乌头碱 免疫 手术期间 

分 类 号：R614[医药卫生—麻醉学]