不同麻醉方法对结直肠肿瘤腔镜手术患者IL-17和IL-23的影响

发布时间：2019-01-05 14:16

【摘要】：目的比较结肠、直肠肿瘤腔镜手术中连续硬膜外复合静脉麻醉,全凭静脉麻醉和全凭吸入麻醉对患者血浆促炎性细胞因子IL-17和IL-23的影响。方法患者随机分成3组(n=20):连续硬膜外复合静脉麻醉组(A组):布比卡因连续硬膜外泵注维持麻醉,复合丙泊酚静脉泵注镇静;全凭静脉麻醉组(B组):术中静脉泵注丙泊酚镇静,芬太尼镇痛;全凭吸入麻醉组(C组):术中吸入笑气、氧气和七氟烷维持麻醉。ELISA法检测血浆细胞因子IL-17和IL-23浓度。结果麻醉诱导前(T0)三组患者血浆IL-17和IL-23浓度处于高水平,且三组间无明显差异(P0.05);与T0相比,手术开始后60 min(T1)、术后30 min(T2)和术后24 h(T3)三组患者血浆IL-17和IL-23浓度明显降低,其中T1时上述指标明显低于T2和T3时,T2时明显低于T3时(P0.05);与C组相比,A、B组两组患者在T1、T2两时间点血浆IL-17和IL-23浓度明显降低,且A组上述指标明显低于B组(P0.05);而在T3时间点三组无明显差异(P0.05)。结论三种麻醉方法均可明显降低IL-17和IL-23浓度,故对结直肠肿瘤患者有抑制促炎性反应作用,其中连续硬膜外复合静脉麻醉好于全凭静脉麻醉,全凭静脉麻醉好于全凭吸入麻醉。
[Abstract]:Objective to compare the effects of continuous epidural combined intravenous anesthesia, total intravenous anesthesia and total inhalation anesthesia on plasma proinflammatory cytokines (IL-17 and IL-23) in patients with colorectal neoplasms undergoing endoscopic surgery. Methods patients were randomly divided into 3 groups (n = 20): continuous epidural combined intravenous anesthesia group (group A): bupivacaine continuous epidural pump maintenance anesthesia, combined propofol intravenous injection sedation; Total intravenous anesthesia group (group B): intravenous infusion of propofol sedation, fentanyl analgesia; Total anesthesia group (group C): inhaled nitrous oxide, oxygen and sevoflurane to maintain anesthesia during operation. Plasma cytokines IL-17 and IL-23 were measured by ELISA method. Results before anesthesia induction (T0), the levels of plasma IL-17 and IL-23 in the three groups were high, and there was no significant difference among the three groups (P0.05). Compared with T0, plasma IL-17 and IL-23 levels were significantly decreased at 60 min (T1), 30 min (T2) and 24 h (T3) after operation, and were significantly lower at T1 than those at T2 and T3, respectively. T2 was significantly lower than T3 (P0.05). Compared with group C, plasma IL-17 and IL-23 levels in group A were significantly lower than those in group B at T _ 1 and T _ 2, and the above indexes in group A were significantly lower than those in group B (P0.05), but there was no significant difference among the three groups at T3 time point (P0.05). Conclusion the concentration of IL-17 and IL-23 can be significantly reduced by the three anesthesia methods, so it can inhibit the pro-inflammatory response in colorectal cancer patients, and continuous epidural combined intravenous anesthesia is better than total intravenous anesthesia. Total intravenous anesthesia is better than total inhalation anesthesia.
【作者单位】：苏州市立医院本部麻醉科;
【分类号】：R614;R735.34

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