【摘要】：目的比較結(jié)腸、直腸腫瘤腔鏡手術(shù)中連續(xù)硬膜外復合靜脈麻醉,全憑靜脈麻醉和全憑吸入麻醉對患者血漿促炎性細胞因子IL-17和IL-23的影響。方法患者隨機分成3組(n=20):連續(xù)硬膜外復合靜脈麻醉組(A組):布比卡因連續(xù)硬膜外泵注維持麻醉,復合丙泊酚靜脈泵注鎮(zhèn)靜;全憑靜脈麻醉組(B組):術(shù)中靜脈泵注丙泊酚鎮(zhèn)靜,芬太尼鎮(zhèn)痛;全憑吸入麻醉組(C組):術(shù)中吸入笑氣、氧氣和七氟烷維持麻醉。ELISA法檢測血漿細胞因子IL-17和IL-23濃度。結(jié)果麻醉誘導前(T0)三組患者血漿IL-17和IL-23濃度處于高水平,且三組間無明顯差異(P0.05);與T0相比,手術(shù)開始后60 min(T1)、術(shù)后30 min(T2)和術(shù)后24 h(T3)三組患者血漿IL-17和IL-23濃度明顯降低,其中T1時上述指標明顯低于T2和T3時,T2時明顯低于T3時(P0.05);與C組相比,A、B組兩組患者在T1、T2兩時間點血漿IL-17和IL-23濃度明顯降低,且A組上述指標明顯低于B組(P0.05);而在T3時間點三組無明顯差異(P0.05)。結(jié)論三種麻醉方法均可明顯降低IL-17和IL-23濃度,故對結(jié)直腸腫瘤患者有抑制促炎性反應作用,其中連續(xù)硬膜外復合靜脈麻醉好于全憑靜脈麻醉,全憑靜脈麻醉好于全憑吸入麻醉。
[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.
【作者單位】： 蘇州市立醫(yī)院本部麻醉科;
【分類號】：R614;R735.34

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