硬膜外阻滞复合全麻和硬膜外镇痛对食管癌手术患者血浆IL-17和TGF-β1浓度的影响  

The effects of epidural anesthesia and postoperative epidural analgesia on the plasma levels of IL- 17 and TGF- β1 in esophageal carcinoma patients undergoing thoracic surgery

作　　者：张菁[1] 洪涛[1] 

机构地区：[1]常州市第一人民医院,江苏常州213003

出　　处：《常州实用医学》2013年第6期351-353,共3页CHANGZHOU PRACTICAL MEDICINE

摘　　要：目的比较不同麻醉方法及术后镇痛对食管癌手术患者血浆IL-17和TGF-β1浓度的影响。方法将60例择期行食管癌手术患者随机分为4组：I组全凭静脉麻醉，术后行静脉自控镇痛（PCn）；Ⅱ组麻醉方法同I组，术后行硬膜外镇痛（PCEA）；HI组采用静脉麻醉复合胸段硬膜外阻滞（TEA），术后行PCIA；IV组麻醉方法同Ⅲ组，术后行PCEA；于麻醉前（哟）、切皮后2h（TI）、术毕（他）、术后24h（13）、术后48h（T4）采外周静脉血，以酶联免疫法测血浆中IL-17及TGF—β1浓度。结果各组术后外周血中TGF—β1含量均有所下降，但组间比较无显著性差异（P〉0．05）；各组患者IL-17含量与哟比较，I、Ⅱ组在他、B时点有明显升高，组间比较在他、13、T4时点Ⅳ组的IL-17含量比工纽明显降低（P〈0．05）。结论食管癌开胸手术患者无论术中全麻复合TEA或术毕运用PCEA均可减少促炎性，Ih17细胞的分化形成，术中和术后的连续应用效果更佳。Objective To investigate the effects of thoracic epidural anesthesia（TEA）conbind general anesthesia during operation and postoperative epidural analgesia on the plasma levels of IL - 17 and TGF -β1 in esophageal carcinoma patients un- dergoing thoracic surgery. Methods Sixty esophageal carcinoma patients, ASA I - II , were randomly allocated into four groups with 15 cases each.Patients in group I and II were received total intravenous general anesthesia（TIVA）.However patient in group m and IV were given TEA eombind and TIVA during operation. Postoperatively, patients in group I and II were used controlled intravenous analgesia（PCIA） ; however patients in group II and IV were used controlled epidural analgesia（PCEA）.Peripheral blood samples for measurement of TGF- βand IL- 17（as markers of Thl7 cells）were taken before the induction of anesthesia （T0）, at 2h after incision（T1 ）, at 4h after the end of surgery （T2）, 24h after the end of surgery （T3） and 48h after the end of surgery（T4） .The levels of TGF- β1 and IL- 17 in plasma were quantified by enzyme- linked immuno sorbent assay（ElJSA）. Iqosults The levels of TGF - β1 in all groups were decreased significantly at T3 compared with those at TO（ P 〈 0.05）. However there were no differences among four groups（ P 〉 0.05） .The levels of IL - 17 in group I and 11 at T2 and T3 were higher than those at TO（ P 〈 0.05）.The IL- 17 levels in group IV at T2,T3 and T4 were decreased significancy compared with that in group I（ P 〈 0.05）. Conclusion These resluts show that no matter general anesthesia combined with TEA or PCEA only can inhibit stress response.They also can slowdown Th0 cells shift to Thl7 cells, which are pminllammatory.There will get more effective re- sults if TEA combine with PCEA.

关 键 词：TEA PCEA TH17细胞 

分 类 号：R614.42[医药卫生—麻醉学]