硬膜外超前镇痛对食管癌根治术患者血浆细胞因子的影响  

EFFECT OF PRE-EMPTIVE EPIDURAL ANALGESIA ON CYTOKINES IN PATIENTS AFTER RADICAL ESOPHAGEAL CANCER SURGERY

作　　者：俞丽君[1] 黄玉萍[1] 章炳法[1] 黄蓉蓉[1] 

机构地区：[1]浙江省新昌县人民医院麻醉科,浙江新昌312500

出　　处：《河北医科大学学报》2011年第3期303-306,共4页Journal of Hebei Medical University

摘　　要：目的比较硬膜外超前镇痛和术后镇痛对食管癌根治术患者细胞因子的影响。方法择期全麻下拟行食管癌根治术的患者40例,ASA Ⅰ级或Ⅱ级,随机分为2组(n=20),硬膜外超前镇痛组(Ⅰ组)和术后硬膜外镇痛组(Ⅱ组)。于T_(7,8)间隙行硬膜外穿刺并置管。Ⅰ组切皮前约30min硬膜外腔注射0.2%罗哌卡因10mL后接硬膜外腔自控止痛(patient controlled epidural analgesia,PCEA)泵。Ⅱ组患者术毕硬膜外注射0.2%罗哌卡因10mL后接PCEA泵。PCEA药物为,罗哌卡因200 mg加芬太尼200μg用生理盐水稀释为100mL,输注速率2mL/h,PCEA剂量0.5mL,锁定时间15min。于硬膜外穿刺前(T_0)、术后4h(T_1)、24 h(T_2)和48 h(T_3)时,采集外周静脉血4mL,测定血浆肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-4(interleukin-4,IL-4)和白细胞介素-10(interleukin-10,IL-10)的水平。结果与Ⅱ组比较,Ⅰ组TNF-α和IL-6降低(P<0.05),IL-10升高(P>0.05)。结论与术后硬膜外镇痛相比,硬膜外超前镇痛可更好地抑制促炎细胞因子及增加抗炎细胞因子的释放。Objective To investigate the effects of pre-emptive epidural analgesia and postoperative epidural analgesia on cytokines in patients after radical esophageal cancer surgery. Methods Forty ASA I or Ⅱ patients undergoing elective radical esophageal cancer surgery under general anesthesia were randomly divided into two groups（ n = 20 in each group） , pre -emptive epidural analgesia group （group I ） and postoperative epidural analgesia group （group Ⅱ ）. The epidural catheter was placed at T7,8 interspace. In group I the epidural analgesia was started with 0.2% ropivaeaine 10mL at 30 rain before skin incision, while in group Ⅱ started after operation and then were attached to a patient controlled epidural analgesia（PCEA） pump, PCEA with ropivacaine 200mg plus fentanyl 200 μg added to normal saline 100mL in two groups. PCEA was started with background infusion rate 2mL/h, bolus dose 0.5 mL, lockout interval 15 min. Blood samples were taken before epidural catheter was placed （ T0 ）, at 4h （ T0）, 24h （ T2 ） and 48h（ T3 ） after operation for detecting plasma concentrations of tumor necrosis factor - α （ TNF - α ）, interleukin - 4 （ IL - 4 ）, interleukin - 6 （ IL - 6 ） and interleukin - 10 （ IL -10）. Results The level of the plasma concentration of TNF -α and IL- 6 were significantly lower and IL - 10 was significantly higher in group I than those in group Ⅱ （ P 〈 0.05 ）. Conclusion Pre - eruptive epidural analgesia can inhibit the release of pro -inflammatory cytokines and increase the anti -inflammatory cytokines.

关 键 词：镇痛 食管肿瘤 细胞因子类 

分 类 号：R735.1[医药卫生—肿瘤]