不同麻醉方式下腹腔镜宫颈癌根治术患者围术期血浆HMGB1浓度的比较  

Comparison of perioperative plasma HMGB1 concentrations in patients undergoing laparoscopic radical resection of cervical cancer using different anesthetic regimens

作　　者：王平 申华素 刘微[2] 高义 马晓俞 Wang Ping;Shen Huasu;Liu Wei;Gao Yi;Ma Xiaoyu(Department of Anesthesiology,Fourth Hospital of Shijiazhuang City,Shijiazhuang 050011,China;Department of Anesthesiology,The Forth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第四医院麻醉科,050011 [2]河北医科大学第四医院麻醉科,石家庄050011

出　　处：《中华麻醉学杂志》2021年第12期1454-1457,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较不同麻醉方式下腹腔镜宫颈癌根治术患者围术期血浆高迁移率族蛋白1(HMGB1)浓度。方法择期行腹腔镜宫颈癌根治术的患者68例,年龄34~68岁,BMI 19~24 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=34):全身麻醉组(G组)和全身麻醉联合硬膜外麻醉组(GE组)。G组采用咪达唑仑、依托咪酯、顺式阿曲库铵进行麻醉诱导,采用瑞芬太尼、丙泊酚、顺阿曲库铵维持麻醉;GE组麻醉诱导前经L_(1,2)间隙行硬膜外麻醉,待麻醉平面达到T_(6)后进行全身麻醉,方法同G组。术后采用PCIA,维持VAS评分≤3分。于麻醉前10 min(T_(0))、手术结束时(T_(1))、术后1 h(T_(2))、24 h(T_(3))和48 h(T_(4))时,采集外周静脉血样,采用ELISA法测定血浆HMGB1、γ-干扰素(IFN-γ)以及IL-4浓度;通过流式细胞仪检测T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)水平和CD4^(+)/CD8^(+)比值。结果与G组比较,GE组T_(2,4)时血浆IFN-γ和IL-4浓度降低,T_(2~4)时血浆HMGB1浓度降低,T_(2~4)时CD3^(+)、T2时CD4^(+)、T_(2,3)时CD8^(+)水平和CD4^(+)/CD8^(+)比值升高(P<0.05)。结论相比全身麻醉,全身麻醉联合硬膜外麻醉下腹腔镜宫颈癌根治术患者血浆HMGB1浓度更低,进而对免疫功能的影响更小。Objective To compare the perioperative plasma high-mobility group box 1 protein(HMGB1)concentrations in the patients undergoing laparoscopic radical resection of cervical cancer using different anesthetic regimens.Methods Sixty-eight American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 34-68 yr,with body mass index of 19-24 kg/m^(2),undergoing elective laparoscopic radical resection of cervical cancer,were divided into 2 groups(n=34 each)using a random number table method:general anesthesia group(G group)and general anesthesia combined with epidural anesthesia group(GE group).In group G,anesthesia was induced with midazolam,etomidate and cisatracurium and maintained with remifentanil,propofol and cisatracurium.In group GE,an epidural catheter was placed at L_(1,2) interspace before induction of anesthesia,general anesthesia was performed after the anesthesia level reached T6,and the method was similar to those previously described in group G.Patient-controlled intravenous analgesia was used after operation to maintain visual analog scale score≤3 points.Peripheral venous blood samples were collected at 10 min before anesthesia(T_(0)),at the end of operation,and at 1,24 and 48 h after operation(T_(1-4))for determination of plasma concentrations of HMGB1,interferon-gamma(IFN-γ)and interleukin-4(IL-4)(by enzyme-linked immunosorbent assay)levels of T lymphocyte subsets CD3^(+),CD4^(+)and CD8^(+)and CD4^(+)/CD8^(+)ratio(by flow cytometry).Results Compared with group G,the plasma concentrations of IFN-γ and IL-4 were significantly decreased at T_(2,4),the plasma concentration of HMGB1 was decreased at T_(2-4),and the levels of CD3^(+)at T_(2-4),CD4^(+)at T_(2) and CD8^(+)at T_(2,3) and CD4^(+)/CD8^(+)ratio were increased in group GE(P<0.05).Conclusion The plasma HMGB1 concentration is lower,which has less impact on immune function of the patients undergoing laparoscopic radical resection of cervical cancer with the combination of general anesthesia and epidural anesthesia than that with gen

关 键 词：高迁移率族蛋白质类 麻醉 全身 麻醉 硬膜外 腹腔镜检查 宫颈肿瘤 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]