全身麻醉对肝癌患者射频消融术后炎性反应的影响  

Effects of general anesthesia on inflammatory response in patients after radiofrequency ablation for liver cancer

作　　者：冯惠民[1] 李廷坤[1] 吕帅国[1] 冯艳平[1] 李长生[1] 

机构地区：[1]河南省肿瘤医院麻醉科,郑州市450003

出　　处：《中华麻醉学杂志》2011年第12期1440-1442,共3页Chinese Journal of Anesthesiology

基　　金：河南省2011年科技发展计划（112102310344）

摘　　要：目的评价全身麻醉对肝癌患者射频消融术后炎性反应的影响。方法择期行射频消融术的原发性肝癌患者40例，年龄40～64岁，体重50-75kg，性别不限，ASA分级Ⅱ或Ⅲ级，肝功能Child—Pugh分级A级。采用随机数字表法，将患者随机分为2组（n=20）：局部麻醉组（L组）和全身麻醉组（G组）。G组麻醉诱导：静脉注射异丙酚1～2mg／kg和芬太尼2～4μg／kg，插入喉罩后行机械通气。麻醉维持：吸入2％七氟醚，靶控输注瑞芬太尼，血浆靶浓度4μg／L。术中维持BIS值45～60。L组穿刺部位注射1％利多卡因进行局部浸润麻醉。于麻醉前、术后1、24和48h时抽取上肢静脉血样5ml，采用ELISA法检测血清IL-6、IL-10、IL-8和热休克蛋白70（HSP70）的浓度。结果与L组比较，G组术后1、24和48h时血清IL-6和IL-8的浓度降低，术后24和48h时血清HSP70浓度降低（P〈0．05）；两组术后各时点血清IL-10浓度差异无统计学意义（P〉0．05）。结论全身麻醉可抑制肝癌患者射频消融术后HSP70和促炎因子的生成，从而减轻全身炎性反应。Objective To investigate the effects of general anesthesia on inflammatory response in patients after radiofrequency ablation for liver cancer. Methods Forty ASA Ⅱ or Ⅲ and Child-Pugh A patients of both sexes aged 40-64 yr, weighing 50-75 kg, undergoing radiofrequency ablation for liver cancer, were randomly di- vided into 2 groups （ n = 20 each） ： local anesthesia group （group L） and general anesthesia group （group G）. In group G anesthesia was induced with propofol 1-2 mg/kg and fentanyl 2-4 μg/kg and maintained with inhalation of 2 % sevoflurane and TCI remifentanil （Cp 4 μg/L）. Laryngeal mask airway was inserted, and the patients were mechanically ventilated. BIS value was maintained at 45-60. In group L local infiltration anesthesia was performed in puncture site with 2 % lidocaine. Blood samples were taken from veins of upper limb for determination of serum concentrations of IL-6, IL-8, IL-10 and heat shock protein 70 （HSP70） before anesthesia and 1, 24 and 48 h after operation by ELISA.Results Compared with group L, serum concentrations of IL-6 and IL-8 were significantly decreased at 1, 24 and 48 h after operation, whlie serum concentration of HSP70 was decreased at 24 and 48 h after operation in group G （P 〈 0.05）. There was no significant difference in serum concentration of IL-10 between the two groups （ P 〉 0.05）. Conclusion General anesthesia can inhibit the production of proiaflammatory factor and HSP70 and reduce systemic inflammatory response after radiofrequency ablation for liver cancer.

关 键 词：麻醉 全身 炎症 导管消融术 肝肿瘤 

分 类 号：R614[医药卫生—麻醉学]