三种不同液体急性高容量血液稀释对脊柱手术患者围术期血清TNF-α、IL-6、IL-10及sICAM-1水平的影响  

The Influence of Three Different Solutions on Perioperative Serum TNF-α,IL-6,IL-10 and sICAM-1 after Acute Hypervolemic Hemodilution in Spinal Surgery Patients

作　　者：吕晨[1] 邹建玲[1] 叶玲[1] 

机构地区：[1]浙江中医药大学附属第一医院,杭州310006

出　　处：《浙江中医药大学学报》2012年第3期273-275,共3页Journal of Zhejiang Chinese Medical University

摘　　要：[目的]探讨三种不同液体急性高容量血液稀释(AHHD)对机体围术期血清炎性细胞因子和黏附分子的影响。[方法]选择45例美国麻醉师协会(ASA)Ⅰ～Ⅱ级择期骨科脊柱手术患者,随即分成三组,全麻诱导后30min内分别输入15mL.kg-1的复方氯化钠溶液、羟乙基淀粉(130/0.4)和聚明胶肽溶液。于AHHD前、AHHD后即刻、2h、6h和24h用ELISA法检测血清TNF-α、IL-6、IL-10和sICAM-1的浓度。[结果]各组自AHHD 2h后各细胞因子和黏附分子血清水平均较AHHD前显著升高(P<0.05),但羟乙基淀粉(130/0.4)组sICAM-1血清水平与AHHD前比较无显著差异(P>0.05);羟乙基淀粉(130/0.4)组在AHHD 2h后,IL-10浓度较其余组显著升高,而sICAM-1浓度则较低(P<0.05);聚明胶肽组TNF-α、IL-6和sICAM-1浓度升高显著(P>0.05),但IL-10则维持在较低浓度。[结论]本研究发现羟乙基淀粉(130/0.4)用于AHHD可抑制围术期过强的炎症反应和免疫应答,与复方氯化钠溶液及聚明胶肽相比,对机体影响较小,更为安全。[ Objective ] To compare the influence of three different solutions on serum inflammatory cytokines and adhesion molecule level changes after preoperative acute hypervolemic hemodilution（AHHD） in perioperative patients. [Methods] Forty-five ASA Grade Ⅰ - Ⅱ patients undergoing selective orthopedic spinal surgery under general anesthesia were randomly divided into 3 groups： Ringer＇s solution group, hydroxyethylh starch （130/0.4） group and polygeline group. All of the studied patients received intravenous infusion of 15mL/Kg, one of three different solutions after induction of general anesthesia. Serum concentration of TNF-α,IL-6,IL-10 and slCAM-1 were assayed by ELISA respectively before AHHD, after AHHD and 2h, 6h, 24h later. [ Result ] 1. It was showed that levels of all the cytokines and adhesion molecule increased markedly at any time after AHHD 2h later in all groups, however, the changes of sICAM-1 level in hydroxyethylh starch（130/0.4） group were not significant between AHHD before and after. 2. The concentration of IL-10 was prominent higher in hydroxyethylh starch（130/0.4） group at any time after AHHD 2h later than that in other two groups, inversely, sICAM-1 was lower. 3. In polygefine group, TNF-α, IL-6 and sICAM-1 levels increased obviously after AHHD and always higher than that in other groups at any time, but IL-10 concentration maintained in lower level. [Conclusion] Hydroxyethylh starch （130/0.4） has the advantages in suppression of excessive inflammatory reaction and immunologic response over Ringer＇s solution and polygeliue in perioperative patients.

关 键 词：急性高容量血液稀释 羟乙基淀粉 细胞因子 黏附分子 围手术期 

分 类 号：R552[医药卫生—血液循环系统疾病]