二氧化碳气腹下丙泊酚脂肪乳含量对血浆CGRP浓度与IL-6、TNF-α的影响  

The Influence of Propofol with Different Triglyceride for CGRP and IL-6 and TNF-Α under Carbon Dioxide Pneumoperitoneum

作　　者：奉光举[1] 冯洁华[1] 罗晓敏[1] 涂汉坤 聂玲[1] 吕倩茹[1] 姚尚龙[2] FENG Guangju;FENG Jiehua;LUO Xiaomin;TU Hankun;NIE Ling;LV Qianru;YAO Shanglong(Shenzhen Nanshan District People's Hospital,Shenzhen 518000,China)

机构地区：[1]深圳市南山区人民医院,广东深圳518000 [2]华中科技大学武汉协和医院,湖北武汉430000

出　　处：《现代医院》2019年第6期904-907,共4页Modern Hospitals

摘　　要：目的探讨腹腔镜直肠癌根治手术中不同脂肪乳丙泊酚麻醉二氧化碳气腹下血浆降钙素基因相关肽(CGRP)浓度与炎症介质白介素-6(IL-6)、肿瘤坏死因子-ɑ(TNF-α)浓度的关系。方法选择年龄60~80岁,ASAⅠ~Ⅱ级,择期行腹腔镜下直肠癌根治术患者40例,MARSH模式血浆浓度靶控输注进行全凭丙泊酚麻醉诱导与维持,随机分为长链脂肪乳(LCT)组和中长链脂肪乳(MCT/LCT)组,协同芬太尼3μg/kg和维库溴铵0. 1 mg/kg气管插管,术中丙泊酚2~3μg/m L及瑞芬太尼0. 2~0. 25μg(kg·min)持续泵注,间断注射舒芬太尼及维库溴铵维持麻醉。观察麻醉过程中CGRP、IL-6、TNF-α浓度变化及手术前后血常规白细胞总数及各比例变化。结果 LCT组气腹后1 h、3 h及术后24 h CGRP浓度升高,两组气腹后3 h及术后24 h IL-6浓度上升,TNF-α浓度在手术前后变化不明显,LCT组术后48 h白细胞总数低于手术前。结论腹腔镜直肠癌根治术气腹后IL-6浓度增加,但TNF-ɑ浓度、白细胞总数维持正常或下降,与中长链和长链脂肪乳维持及增加CGRP浓度产生抗炎作用有关。Objective To looking for the influence of propofol with different triglyceride for CGRP and IL-6 and TNF-α under carbon dioxide pneumoperitoneum under laparoscopic surgery. Methods The age of 60-80 years old,ASAI-II grade,40 patients undergoing elective laparoscopic radical resection of rectal cancer,MARSH mode plasma concentration target-controlled infusion was induced and maintained by propofol anesthesia,randomly divided into long-chain fat emulsion( LCT) group and medium long-chain fat emulsion( MCT/LCT) group,combined with fentanyl 3 μg/kg and vecuronium 0. 1 mg/kg tracheal intubation,intraoperative propofol 2 ~ 3 μg/m L and remifen Tai Ni 0. 2 ~ 0. 25 μg/( kg·min) continuous pumping,intermittent injection of sufentanil and vecuronium to maintain anesthesia. The changes of CGRP,IL-6 and TNF-α concentrations during anesthesia and the total number of white blood cells and their proportions before and after surgery were observed. Results The CGRP concentration increased at 1 hour,3 hours and 24 hours after pneumoperitoneum in the LCT group. The IL-6 concentration increased 3 hours after the pneumoperitoneum and 24 hours after the operation. The TNF-α concentration did not change significantly before and after surgery. LCT The total number of white blood cells in the group 48 hours after surgery was lower than that before surgery. Conclusion Although the concertration of IL-6 increase in perioperative period,but the concentration of TNF-α and the count of WBC were not different change,the anti-inflammatory efficiency came from the MCT/LCT group can keep the concentration of CGRP and the LCT group can increase it.

关 键 词：长链脂肪乳丙泊酚 中长链脂肪乳丙泊酚 降钙素基因相关肽 白介素-6 肿瘤坏死因子-ɑ 

分 类 号：R614.2[医药卫生—麻醉学]