麻醉方法对上腹部手术围术期血清IL-6、皮质醇及T细胞亚群的影响  

Influence of anesthetic technique on serum IL-6, cortisol and T cell subsections following upper abdominal surgery

作　　者：张红斌[1] 谭武菊[1] 许永广[1] 宋振瑞[1] 

机构地区：[1]山东省立医院麻醉科,济南市250021

出　　处：《中华麻醉学杂志》2000年第4期220-222,共3页Chinese Journal of Anesthesiology

摘　　要：目的　探讨 3种麻醉方法对应激性神经内分泌免疫反应的影响。方法　 30例择期行上腹部手术病人随机分为 3组 :硬膜外阻滞组 (Ⅰ组 )、静吸复合全麻组 (Ⅱ组 )、硬膜外阻滞加全麻组(Ⅲ组 )。测定麻醉诱导前、手术切皮前、手术 1h、术毕、术后 1d、术后 5d血清IL 6、皮质醇浓度及T细胞亚群。结果　Ⅰ及Ⅱ组血清IL 6浓度显著升高 (P <0 0 1) ,而Ⅲ组术中、术后血清IL 6浓度无显著变化 (P >0 0 5 ) ;30例病人术毕血清IL 6浓度与手术时间呈正相关 (r =0 6 1,P <0 0 1)。Ⅲ组手术 1h血清皮质醇浓度较诱导前降低 ,与Ⅰ组比较显著降低 (P <0 0 5 )。Ⅲ组术后 5dCD4 CD8显著高于Ⅱ组 (P <0 0 5 )。结论　硬膜外加全麻可减轻上腹部手术术中、术后血清IL 6、皮质醇浓度的升高及细胞免疫功能的抑制。Objective To study the effects of three anesthetic techniques on the neuroendocrine and immune responses to surgical stress Methods Thirty patients undergoing elective upper abdominal surgery, were allocated randomly to epidural anesthesia group(groupⅠ), general anesthesia group (groupⅡ)and combination of epidural and general anesthesia group(group Ⅲ ) The serum concentrations of IL 6 and cortisol, and T cell subsections were measured respectively before induction, before incision, 1 h following the operation, at the operative end , on the first and fifth postoperative day Results Serum IL 6 concentrations increased significantly in groupⅠand Ⅱ(P<0 01),but remained unchanged markedly in group Ⅲ(P>0 05) during and after the operation, and serum IL 6 concentrations of all patients at the operative end were correlated positively to the operative duration (r=0 61, P<0 01) In group Ⅲ, serum cortisol concentration 1 h following operation was lower than that before induction , decreased significantly compared with that in group Ⅰ(P<0 05) CD4/CD8 of group Ⅲ on the fifth postoperative day was significantly higher than that of group Ⅱ(P<0 05) Conclusions The combined epidural general anesthesia can reduce the stress response and improve the cellular immune function following upper abdominal operations

关 键 词：腹部外科手术 IL-6 皮质醇 T细胞亚群 麻醉 

分 类 号：R614[医药卫生—麻醉学]