异氟醚和七氟醚麻醉对肝癌患者围术期血浆细胞因子的影响

摘要

目的：探讨七氟醚和异氟醚麻醉对肝癌射频消融术患者围术期血浆细胞因子的影响。方法：原发性肝癌患者120例，ASAⅠ-Ⅱ级，男83例，女37例，年龄36-79岁，体重51-85kg。随机分为异氟醚组（I组）和七氟醚组（S组），每组60例择期行在超声引导下经皮肝穿刺肝癌射频消融术。麻醉诱导后行气管插管连接麻醉机辅助呼吸，麻醉维持使BIS于40-60，BP、HR高于基础值20％以上时，追加0．05-0．1mg芬太尼，适时追加维库溴铵。分别于麻醉诱导前（T0）、手术开始时（T1）、手术结束时（T2）及术后24h（T3），采集静脉血，应用酶联免疫吸附（ELISA）方法测定血清IL-4、IL-10、HMGB1及VEGF-1浓度。结果：T0，T1，T2及T3时间点，I组与S组血浆中细胞因子IL-4、IL-10、HMGB1和VEGF-1的浓度均随时间升高，T3时间点血浆中细胞因子浓度达到释放高峰。在T2及T3时间点，与I组比较，S组IL-4及IL-10升高，HMGB1和VEGF-1的浓度降低，具有统计学意义（P＜0．05）。T0及T1时间点，两组血浆中IL-4、IL-10、HMGB1和VEGF-1浓度差异无统计学意义（P＞0．05）。结论：七氟醚比异氟醚麻醉能够更好地调节肝癌患者围术期血浆炎症因子的生成，从而改善肿瘤患者的预后。%Objective:To investigate the effects of isoflurane and sevoflurane on plasma cytokines in liver cancer patients during perioperative period.Methods:One hundred and twenty ASAⅠ-Ⅱpatients,83 male and 37 female, aged 36-79,were randomly assigned to two groups:Isoflurane group(Group I)and sevoflurane group(Group S).60 patients of each group underwent elective percutaneous liver puncture radiofrequency ablation of liver cancer with ul-trasound.After anesthesia induction,patients were made endotracheal intubation to breathe through anesthesia ma-chine,and maintained with BIS 40-60.When BP and HR were 20%higher than the basic value,an additional 0.05-0.1 mg fentanyl was used to control BP and HR and timely supplementary vecuronium.Blood samples were collected from peripheral vein before anesthesia(T0 ),at the beginning of operation(T1 ),at the end of operation(T2 )and 24h (T3 )after operation for determination of plasma IL-4,IL-10,HMGB1 and VEGF-1 using ELISA.Results:In T0 , T1 ,T2 and T3 ,the concentration of IL-4,IL-10,HMGB1 and VEGF -1 were increased with time,and the peak concentration was at T3 .Compared with group I,in T2 and T3 ,IL-4 and IL-10 levels were significantly elevated;HMGB1 and VEGF-1 were significantly reduced in group S(P<0.05).In T0 and T1 ,IL-4,IL-10,HMGB1 and VEGF-1 had no significant difference between the two groups S and I (P>0.05 ).Conclusion:Compared with isoflurane,sevoflurane preferably regulates the release of IL-4,IL-10,HMGB1 and VEGF-1 during perioperative period of liver cancer surgery,and improves the prognosis of cancer patients.