异丙酚和依托咪酯对腰椎间盘突出手术过程相关细胞因子影响的研究  

Effects of propofol and etomidate on serum-related cytokines in lumbar disc prolapse surgery

作　　者：郭鹏[1] 刘世平[1] 张文生[1] 徐礼鲜 李陕区[3] 

机构地区：[1]延安市人民医院骨科,陕西延安716000 [2]第四军医大学口腔医院麻醉科,陕西西安710032 [3]第四军医大学唐都医院门诊部,陕西西安710038

出　　处：《局解手术学杂志》2013年第3期269-271,共3页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金资助项目(39580683)

摘　　要：目的比较研究异丙酚和依托咪酯对腰椎间盘突出症手术过程血清相关细胞因子影响并讨论其临床意义。方法2009年7月至2012年6月延安市人民医院经CT、MRI诊断的腰椎间盘突出症患者84例,按手术时采用的麻醉药物的不同分为异丙酚组(n=43)和依托咪酯组(n=41)。异丙酚组诱导依次采用异丙酚、芬太尼和维库溴铵;依托咪酯组采用依托咪酯、芬太尼和维库溴铵。麻醉维持吸入异氟醚,间断追加异丙酚、芬太尼和维库溴铵。2组患者均于术前、诱导后、手术开始1 h和手术结束时抽静脉血离心提取血清,用放射免疫法测定丙二醇(MDA)、超氧化物歧化酶(SOD)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、血栓素(TX)、内皮素(ET)、前列腺素E(PGE)和降钙素(CA)水平。结果 2组患者麻醉过程中生命体征平稳,无麻醉相关死亡。2组患者术前血清MDA、SOD、IL-6、TNF、TX、ET、PGE和CA均无统计学差异(P>0.05),诱导后异丙酚组上述各指标均明显降低(P<0.05),且随手术时间推延,差异更明显(P<0.01)。结论腰椎间盘突出症手术采用异丙酚麻醉较依托咪酯能更有效地降低手术过程血清相关细胞因子水平,从而影响机体的生化代谢,其机制有待进一步探讨。Objective To investigate effects of propofol and etomidate on serum-related cytokines in lumbar disc prolapse surgery and to discuss the clinical significance. Methods Divided the 84 patients who were diagnosed by CT and MRI from July 2009 to June 2012 in our hospital into the propofol group （n = 43 ）and etomidate group （n = 41 ） according to the different anaesthetic. The propofol group were induced with propofol, fentaini and vecuronium in turn, and the etomidate group were induced with etomidate, fentaini and vecuronium in turn. There were anaesthesia maintenance with inhales isoflurane, and propofol ,fentaini and vecuronium were interruptedly supplement. The venous blood was collected to centrifuge before operation, after induction, 1 hour after the surgery started and at the end of surgery. Serum malonie dialdehyde （MDA） , superoxide dismutase （ SOD ） , interleukin-6 （ IL-6 ） , tumor necrosis factor （TNF） , thromboxane （ TX ） , endothelin （ET） , prostaglandin E （PGE）and caleitonin（CA） were measured by radioimmunoassay（RIA）. Results Vital signs of the two groups is stable during the surgery, and there was no anesthesia-related deaths. There was no statistics significance in terms of MDA, SOD, IL-6,TNF,TX, ET, PGE and CA before operation （P 〉 0.05 ）. After induced with propofol, the above index of the propofol group were obviously reduced （P 〈 0.05 ）, and as time gets longer, the difference is more obvious （P 〈 0.01 ）. Conclusion The results suggest that using propofol anesthesia is better than using etomidate during lumbar intervertebral disc prolapse surgery since it can effectively reduce serum cytokine levels, thus affecting organism biochemistry metabolism. And its mechanism needing a further study.

关 键 词：异丙酚 依托咪酯 腰椎间盘突出症 手术 细胞因子 

分 类 号：R614.2[医药卫生—麻醉学]