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

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（P＞0．05）；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（ P＜0．05）；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（ P＜0．05）；而在T3时间点三组无明显差异（ P＞0．05）。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。%Objective To compare the effects of continuous epidural block with intravenous anesthe-sia, total intravenous anesthesia and total inhalational anesthesia on pro-inflammatory cytokines IL-17 and IL-23 serum levels in patients undergoing colorectal cancer laparoscopic surgery .Methods All the pa-tients were randomly divided into 3 groups ( n=20 ):continuous epidural block combined intravenous an-esthesia group ( A group ):patients received continuous epidural anesthesia of bupivacaine , and received intravenous anesthesia with propofol;total intravenous anesthesia group ( B group):patients received total intravenous anesthesia with propofol and fentanil;total inhalational anesthesia group ( C group ): patients received total inhalational anesthesia with sevoflurane in O 2 and Nitrous Oxide .Serum levels of IL-17 and IL-23 were quantified .Results In the three groups ,levels of IL-17 and IL-23 were high prior to induc-tion of anesthesia(T0),and there was no difference between three groups (P>0.05).Compared with T0, levels of IL-17 and IL-23 significantly decreased at 60 min after the start of surgery ( T1 ) ,30 min post-surgery(T2) and 24 h post-surgery(T3);Levels of IL-17 and IL-23 were significantly lower at T1 than T2 and T3,and they were significantly lower at T2 than T3(P<0.05).At T1 and T2,levels of IL-17 and IL-23 were significantly lower in A group than B group ,and they were significantly lower in B group than C group ( P<0 .05 );there was no difference between three groups at 24 h post-surgery ( P>0 .05 ) .Con-clusions Levels of IL-17 and IL-23 significantly decrease in patients received the three anesthetic tech-niques,so it could attenuate pro-inflammation of patients undergoing colorectal cancer laparoscopic surgery .In this respect , continuous epidural block combined with intravenous anesthesia is the best .Total intravenous anesthesia is better than total inhalational anesthesia .