腰椎间盘突出症手术前后相关细胞因子和应激生化指标变化的研究

摘要

目的 研究腰椎间盘突出症手术前后相关细胞因子和应激生化指标变化并讨论临床意义.方法 选择2009年7月～2012年6月经CT和/或MRI诊断的腰椎间盘突出症患者84例,男性58例,女性26例,平均年龄(39.8±13.5)岁,包括突出型56例,游离型17例和凸起型11例.患者用异丙酚连续硬膜外麻醉,根据不同类型进行手术处理,术后常规防感染及支持治疗.患者分别于术前、术后1天、1周和2周早晨空腹分别抽取静脉血用γ放射免疫法测定血清丙二醇(MDA)、超氧化物歧化酶(SOD)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF)、血栓素(TX)、内皮素(ET)、前列腺素E(PGE)和降钙素(calcitonin,CA),结果经统计学处理.结果 患者术中生命体征维持平稳,无手术相关死亡病例.术后恢复状况均良好,2周后治愈有效率92.9%(78/84).患者手术后1天血清MDA,SOD,IL-6,TNF,TX,ET,PGE和CA均明显升高(t=2.401～3.128,P均＜0.01),术后1周开始下降(t=1.698～3.128,P＜0.05~0.01),2周后基本恢复正常(t=0.257～1.149,P均＞0.05).结论 腰椎间盘突出症手术可以使体内相关细胞因子和应激生化指标发生改变,这一变化除手术创伤外,可能还与临床采用异丙酚麻醉药有关,这一生化代谢发生变化的机理有待进一步研究.%Objective To study cytokine changes and stress biochemical index,and discuss the clinical significance of the study of lumbar disc herniation before and after surgery.Methods By CT and/or MRI diagnosis,84 patients with lumbar disc her-niation were selected from July 2009 to June 2012,male 58 cases,female 26 cases,age 39.8±13.5 years old,including prominent 56 cases,free 17cases and 11 cases of convex type.According to the different the types,the patients were made surgery by propofol continuous epidural anesthesia, and conventional anti-infection and supportive care after surgery.Patients with preoperative,postoperative 1 day,1 and 2 weeks of morning fasting serum propylene glycol (MDA) was extracted from venous blood with γ radioimmunoassay, superoxide dismutase (SOD) , interleukin -6 (IL-6) , tumor necrosis factor (TNF), thromboxane (TX) ,endothelin (ET) ,prostaglandin E (PGE) and calcitonin (calcitonin,CA) , the results were statistically.Results Patients with intraoperative had vital signs remained stable, no surgery-related deaths.Postoperative recoveries were in good condition,and two weeks after the cure efficiency of 92.9% (78/84).Serum MDA,SOD, IL-6,TNF,TX,ET, PGE and CA patients after surgery 1 day were significantly increased (t=2.401~3.128, P<0.01), started to decline (t= 1.698~3.128,P<0.05 to 0.01) in 1 weeks after operation,recovery normal (t=0.257~1.149, P>0.05) after 2 weeks.Conclusion The results have showed that cytokines and stress biochemical index for lumbar intervertebral disc prolapse could make changes in surgery,this change in addition to the surgical trauma,possibly also with the clinical use of propofol anesthetics related body biochemical metabolic abnormalities occurred mechanism needs further study.