不同液体预扩容对颅脑外伤患者围术期血清TNF-αIL-6水平的影响和意义  

Effect of different liquid proload on serum levels of inflammatory cytokines in patients with traumatic brain injury

作　　者：何焕钟[1] 周惠芬[1] 钱玉芳[1] 徐恒艺[1] 闫仁福[2] 孟志鹏[1] 王钱荣[1] 闵辉[3] 

机构地区：[1]湖州市中心医院麻醉科,江苏313000 [2]湖州市中心医院神经外科,江苏313000 [3]湖州市中心医院检验科,江苏313000

出　　处：《中国急救医学》2011年第4期314-317,共4页Chinese Journal of Critical Care Medicine

基　　金：基金项目：湖州市科技局科研计划项目（No.2008ys34）

摘　　要：目的 研究不同液体预扩容对颅脑外伤患者围术期血清肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）水平的影响.方法 60例颅脑外伤患者需要手术治疗,随机分成两组,即复方乳酸钠（LR）组和6%羟乙基淀粉（HES）组.术前分别输注复方乳酸钠20 mL/kg,6%羟乙基淀粉10 mL/kg.检测血流动力学及血气分析,记录液体出入量及各组20%甘露醇及去甲肾上腺素的用量.测定麻醉前及术毕时两组患者血清TNF-α和IL-6水平.另外,抽取30份健康体检人员血清作为对照组.结果 两组患者术前血清TNF-α、IL-6水平差异无统计学意义.与HES组比较,LR组术毕时TNF-α、IL-6水平明显增高.LR组术毕时血乳酸值高于HES组.HES组术中20%甘露醇和去甲肾上腺素用量均少于LR组.结论 术前应用6%羟乙基淀粉可降低颅脑外伤患者围术期血清TNF-α、IL-6的表达,对颅脑外伤患者有利.Objective To study the effect of different liquid proload on serum levels of inflammatory eytokines in patients with traumatic brain injury （TBI）. Methods 60 patients with brain injury required surgery were randomly divided into 2 groups： compound sodium lactate （LR） group（n = 30）, in which 20 mL/kg LR was injected before the anesthesia; and 6% hydroxyethyl starch （HES） group, in which 10 mL/kg HES was injected . Hemndynamic variables, the arterial blood gas analysis and blood electrolytes were recorded before treatment （ T 1）, after the load capacity （ T2 ）, after the induction of anesthesia （ T3 ）, when the dura incision （ T4 ） and the end of surgery （ T5 ） respectively. Serum tumor necrosis factor （TNF -α） and interleukin -6 （IL -6） levels were analyzed through the femoral vein blood with enzyme linked immunosorbent assay （ELISA） before and after surgery. Results Compared with healthy people, TNF - α and interleukin - 6 levels in serum of all the patients with TBI were significantly increased after trauma. There was no significant difference in TNF - α and IL - 6 levels of all the patients before surgery. Compared with HES group, TNF - α, IL - 6 increased significantly in LR group after surgery. The blood lactate values of LR group were higher than those of HES group after surgery. The amount of mannitol and norepinephrine administrated in HES group was less than that in the LR group. Conclusion HES can inhibit the release of inflammatory cytokines and decrease the serum levels of cytokines in patients with traumatic brain injury.

关 键 词：颅脑外伤 容量复苏 羟乙基淀粉 血清 肿瘤坏死因子-α(TNF-α) 白细胞介素-6(IL-6) 

分 类 号：R442.2[医药卫生—诊断学]