三种不同液体急性高容量血液稀释对脊柱手术患者围术期血清TNF-α、IL-6、IL-10及sICAM-1水平的影响

摘要

[Objective] To compare the influence of three different solutions on serum inflammatory cytokines and adhesion molecule level changes after preoperative acute hypervolemic hemodiluaon(AHHD) in perioperative patients.[Methods] Forty-five ASA Grade I - II patients undergoing selective orthopedic spinal surgery under general anesthesia were randomly divided into 3 groups: Ringer's solution group, hydroxyethylh starch (130/0.4) group and polygeline group. All of the studied patients received intravenous infusion of 15mL/Kg, one of three different solutions after induction of general anesthesia. Serum concentration of TNF-α,IL-6,IL-10 and sICAM-1 were assayed by EL1SA respectively before AHHD, after AHHD and 2h, 6h, 24h later. [Result] 1. It was showed that levels of all the cytokines and adhesion molecule increased markedly at any time after AHHD 2h later in all groups, however, the changes of sICAM-1 level in hydroxyethylh starch(130/0.4) group were not significant between AHHD before and after. 2. The concentration of IL-10 was prominent higher in hydroxyethylh starch(l 30/0.4) group at any time after AHHD 2h later than that in other two groups, inversely, sICAM-1 was lower. 3. In polygeline group, TNF-α, IL-6 and sICAM-1 levels increased obviously after AHHD and always higher than that in other groups at any time, but IL-10 concentration maintained in lower level. [Conclusion] Hydroxyethylh starch (130/0.4) has the advantages in suppression of excessive inflammatory reaction and lmmunologic response over Ringer's solution and polygeline in perioperative patients.%[目的]探讨三种不同液体急性高容量血液稀释(AHHD)对机体重术期血清炎性细胞因子和黏附分子的影响.[方法]选择45例美国麻醉师协会(ASA)Ⅰ～Ⅱ级择期骨科脊柱手术患者,随即分成三组,全麻诱导后30min内分别输入15mL·kg-1的复方氯化钠溶液、羟乙基淀粉(130/0.4)和聚明胶肽溶液.于AHHD前、AHHD后即刻、2h、6h和241用ELISA法检测血清TNF-α、IL-6、IL-10和sICAM -1的浓度.[结果]各组自AHHD 2h后各细胞因子和黏附分子血清水平均较AHHD前显著升高(P＜0.05),但羟乙基淀粉(130/0.4)组sICAM -1血清水平与AHHD前比较无显著差异(P＞0.05)；羟乙基淀粉(130/0.4)组在AHHD 2h后,IL-10浓度较其余组显著升高,而sICAM-1浓度则较低(P＜0.05)；聚明胶肽组TNF-α、IL-6和sICAM-1浓度升高显著(P＞0.05),但IL-10则维持在较低浓度.[结论]本研究发现羟乙基淀粉(130/0.4)用于AHHD可抑制围术期过强的炎症反应和免疫应答,与复方氯化钠溶液及聚明胶肽相比,对机体影响较小,更为安全.