丙泊酚维持麻醉对单肺通气患者的肺保护作用
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摘要
目的:比较丙泊酚或七氟烷维持麻醉对单肺通气患者围术期炎性细胞因子、氧化—抗氧化平衡的影响,探讨不同的麻醉剂维持对肺的保护作用。方法:择期行胸腔镜肺叶切除术患者40例(样本例数),年龄45～70岁,性别不限,ASAⅠ～Ⅱ级。麻醉诱导均采用咪达唑仑0.05 mg/kg,舒芬太尼0.3～0.5μg/kg,依托咪酯乳剂0.15～0.3 mg/kg,顺苯磺酸阿曲库铵0.2 mg/kg。麻醉维持随机分为两组,丙泊酚组(n=20)静脉泵入4～10mg·kg~(-1)·h~(-1)丙泊酚和七氟烷组(n=20)吸入1%～3%七氟烷,于麻醉诱导前(T_0)、单肺通气开始前(T_1)、单肺通气后30 min(T_2)、术毕(T_3)采集桡动脉血测量血浆IL-6、IL~(-1)0、MDA、SOD浓度。结果:与组内比较,丙泊酚组T_2时刻IL-6、IL~(-1)0、MDA浓度分别为(64.8±26.4)ng/L、(176.6±41.8)ng/L、(6.7±1.5)mmol/L,T_3时刻上述指标水平分别为(79.2±29.1)ng/L、(197.8±51.2)ng/L、(8.2±1.9)mmol/L;与T_0时比较均明显降低(P<0.05);T_2、T_3时刻SOD浓度分别为(66.6±7.0)U/L、(69.6±6.2)U/L,均明显高于T_0时水平(P<0.05);七氟烷组T_2时刻IL-6、IL~(-1)0、MDA浓度分别为(82.3±26.1)ng/L、(152.9±28.3)ng/L、(7.9±1.3)mmol/L,T_3时刻上述指标水平分别为(96.3±18.4)ng/L、(168.2±38.3)ng/L、(9.7±1.6)mmol/L,与T_0时比较均明显升高(P<0.05);T_2、T_3时刻SOD浓度分别为(65.3±9.0)U/L、(58.8±8.5)U/L,与T_0时比较明显降低(P<0.05)。丙泊酚组各时间点IL-6/IL~(-1)0比值均小于T_0水平,而七氟烷组T_2、T_3时IL-6/IL~(-1)0比值均大于T_0水平(P<0.05)。组间比较,与七氟烷组比较,T_1时刻丙泊酚组各指标间差异均无统计学意义(P>0.05);丙泊酚组T_2及T_3时刻IL~(-1)0和SOD浓度均明显升高(P<0.05),IL-6、MDA浓度均明显降低,均有统计学意义(P<0.05)。七氟烷组T_1、T_2、T_3各时间点IL-6/IL~(-1)0比值均大于丙泊酚组相应时间点水平(P<0.05)。结论:丙泊酚维持麻醉更有利于单肺通气促炎细胞因子与抗炎细胞因子平衡、氧化和抗氧化平衡,对单肺通气时所致的肺损伤具有一定保护作用。
Objective To compare the effects of propofol and sevoflurane anesthesia maintain on in?ammatory cytokines and Oxidation-antioxidant balance during perioperative period in patients undergoing one-lung ventilation and to discuss the mechanism of different anesthesia maintain induced lung protection.Methods Forty ASAⅠorⅡpatients(24 male, 16 female)aged 45-70 yr underwent elective pulmonary resection were observed. Anesthesia induction is practiced in two groups by intravenous injection: Midazolam 0.05 mg/kg, Sufentanil 0.3～0.5 ug/kg, Etomidate 0.15～0.3 mg/kg, Cisatracurium Besilate0.2 mg/kg, anesthesia maintain were randomly divided into two groups(n=20 each); continuous intravenous Propofol infusion 4～10 mg/(kg · h)with miero-Pump(GroupⅠ)and inhaled 1%～3% sevo?urane(GroupⅡ). Aterial blood concentrations of IL-6、IL-10、MDA and SOD were measured at before induction of anesthesia( T_0),before the start of one-lung ventilation(T_1),30 min after one-lung ventilation( T_2), and at the end of the operation( T_3). Results Compared within group,the concentrations of IL-6, IL-10 and MDA in propofol group at T_2 were(64.8+26.4) ng/L,(176.6+41.8) ng/L,(6.7+1.5) mmol/L, and the above-mentioned indexes at T_3 were(79.2+29.1) ng/L,(197.8+51.2) ng/L,(8.2+1.9)mmol/L respectively, which were significantly lower than those at T_0(P<0.05). The concentration of SOD at T_2 and T_3 were(66.6+7.0) U/L and(69.6+6.2)U/L, which were significantly higher than those at T_0(P < 0. 05); the concentration of IL-6, IL-10 and MDA at T_2 in sevo?urane group were(82.3+26.1) ng/L,(152.9+28.3) ng/L,(7.9+1.3) mmol/L, and the above indexes at T_3 were(96.3+18.4) ng/L,(1.3) ng/L, respectively. The concentration of SOD at T_2 and T_3 were(65.3+ 9.0) U/L and(58.8 + 8.5) U/L, respectively, which were signi?cantly higher than that at T_0(P < 0.05). The concentration of SOD at T_2 and T_3 was(65.3 + 9.0) U/L and(58.8 + 8.5) U/L, which were signi?cantly lower than that at T_0(P < 0.05). The IL-6/IL-10 ratio of propofol group was lower than that of T_0 at each time point,while the IL-6/IL-10 ratio of sevo?urane group was higher than that of T_0 at T_2 and T_3(P < 0.05). Compared with sevo?urane group, there was no signi?cant difference in the propofol group at T_1(P > 0.05); the concentration of IL-10 and SOD in propofol group at T_2 and T_3 increased signi?cantly(P < 0.05), while the concentration of IL-6 and MDA decreased signi?cantly(P < 0.05). The IL-6/IL-10 ratio of sevo?urane group at T_1, T_2 and T_3 were higher than that of propofol group at corresponding time points(P < 0.05). Conclusion Propofol anesthesia maintain was more conducive to maintaining with pro-in?ammatory cytokines and anti-in?ammatory cytokines balance, oxidation and antioxidant balance in patients undergoing one-lung ventilation. It may protect the lung from the injury during one-lung ventilation.
Objective To compare the effects of propofol and sevoflurane anesthesia maintain on in?ammatory cytokines and Oxidation-antioxidant balance during perioperative period in patients undergoing one-lung ventilation and to discuss the mechanism of different anesthesia maintain induced lung protection.Methods Forty ASAⅠorⅡpatients(24 male, 16 female)aged 45-70 yr underwent elective pulmonary resection were observed. Anesthesia induction is practiced in two groups by intravenous injection: Midazolam 0.05 mg/kg, Sufentanil 0.3～0.5 ug/kg, Etomidate 0.15～0.3 mg/kg, Cisatracurium Besilate0.2 mg/kg, anesthesia maintain were randomly divided into two groups(n=20 each); continuous intravenous Propofol infusion 4～10 mg/(kg · h)with miero-Pump(GroupⅠ)and inhaled 1%～3% sevo?urane(GroupⅡ). Aterial blood concentrations of IL-6、IL-10、MDA and SOD were measured at before induction of anesthesia( T_0),before the start of one-lung ventilation(T_1),30 min after one-lung ventilation( T_2), and at the end of the operation( T_3). Results Compared within group,the concentrations of IL-6, IL-10 and MDA in propofol group at T_2 were(64.8+26.4) ng/L,(176.6+41.8) ng/L,(6.7+1.5) mmol/L, and the above-mentioned indexes at T_3 were(79.2+29.1) ng/L,(197.8+51.2) ng/L,(8.2+1.9)mmol/L respectively, which were significantly lower than those at T_0(P<0.05). The concentration of SOD at T_2 and T_3 were(66.6+7.0) U/L and(69.6+6.2)U/L, which were significantly higher than those at T_0(P < 0. 05); the concentration of IL-6, IL-10 and MDA at T_2 in sevo?urane group were(82.3+26.1) ng/L,(152.9+28.3) ng/L,(7.9+1.3) mmol/L, and the above indexes at T_3 were(96.3+18.4) ng/L,(1.3) ng/L, respectively. The concentration of SOD at T_2 and T_3 were(65.3+ 9.0) U/L and(58.8 + 8.5) U/L, respectively, which were signi?cantly higher than that at T_0(P < 0.05). The concentration of SOD at T_2 and T_3 was(65.3 + 9.0) U/L and(58.8 + 8.5) U/L, which were signi?cantly lower than that at T_0(P < 0.05). The IL-6/IL-10 ratio of propofol group was lower than that of T_0 at each time point,while the IL-6/IL-10 ratio of sevo?urane group was higher than that of T_0 at T_2 and T_3(P < 0.05). Compared with sevo?urane group, there was no signi?cant difference in the propofol group at T_1(P > 0.05); the concentration of IL-10 and SOD in propofol group at T_2 and T_3 increased signi?cantly(P < 0.05), while the concentration of IL-6 and MDA decreased signi?cantly(P < 0.05). The IL-6/IL-10 ratio of sevo?urane group at T_1, T_2 and T_3 were higher than that of propofol group at corresponding time points(P < 0.05). Conclusion Propofol anesthesia maintain was more conducive to maintaining with pro-in?ammatory cytokines and anti-in?ammatory cytokines balance, oxidation and antioxidant balance in patients undergoing one-lung ventilation. It may protect the lung from the injury during one-lung ventilation.
引文
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[10]谢平,帅训军,艾登斌,等.阿芬太尼对单肺通气患者围术期炎症细胞因子IL-6、IL-10及其m RNA表达的影响[J].中国现代医学杂志,2013,23(11):84-87..
[11]Stephanie L,Andreas W,Jean KH,et al.RNAi screen in apoptotic cancer cell-stimulated human macrophages reveals co-regulation of IL-6/IL-10 expression[J].Immunobiology,2013,281(1):40-51.
[12]Inada T,Yamanouehi Y,Jomura S,et al.Effect of propofol and isoflurane anaesthesia on the immune responsetosurgerym[J].AnaestIlesia,2004,59(10):954-959.
[13]Chow CW,Herrera Abreu biT,Suzuki T,et a 1.Oxidative stress and acute lung injury[J].Am J Respir Cell Mol Biol,2003,29(4):427-431.
[14]Yanwu J,Xin Z,Haibo L,et al.Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one lung ventilation[J].Exp Ther Med,2013,6(3):781-785.
[15]Sivrikoz MC,Tuncozgur B,Cekmen M,et al.The role of tissue repefusion in the reexpansion injury of the lungs[J].Eur JCardiothorac Surg,2002,22(5):721-727.
[16]倪剑武,杨涛,张学政,等.七氟烷和异丙酚对单肺通气肺内分流和氧合的影响[J].温州医学院学报,2010,40(3):273-275.
[17]赵晓玲,曾小莉,谢冲,等.丙泊酚或异氟醚麻醉对单肺通气时氧化应激反应的影响[J].临床麻醉学杂志,2010,26(5):376-378.
[18]Sayin MM,Ozatamer O,Tas?z R,et al.Propofol attenuates myocardial lipid peroxide-tion during coronary artery bypass grahing surgery[J].Br J Anaesth,2002,89(5):242-246.
[2]付笑飞,刘东雷,王建军.食管癌手术患者单肺通气时血清炎性细胞因子与氧自由基的检测及意义[J].临床外科杂志,2010,18(9):628-629.
[3]Yanwu J,Xin Z,Haibo L,et al.Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one lung ventilation[J].Exp Ther Med,2013,6(3):781-785.
[4]Abou-Elenain K,Study of the systemic and pulmonary oxidative stress status during exposure to propofol and sevoflurance anaesethesia during thoracic surgery[J].Eur J Anaesthesi ol,2010,27(6):566-571.
[5]Takaono M,Yogosawa T,Okawa-Takatsuji M,et al.Propofol appears to inhibit both IL-6 and IL-10 production by LPS-stimulated PBMCs in vitro.Further study is required to clarify the mechanism of the suppressive effect of propofol[J].Acta Anaesthesiol Scand,2002,6(2):176-179.
[6]Birukova AA,Tian Y,Meliton A,et a 1.Stimulation of Rhosignaling by patho-Logic mechanical stretch is a”second hit”to Rho-independent lung injury indu-ced by IL-6 l[J].Am JPhysiol Lung Cell Mol Physid,2012,302(9):965-975.
[7]Wu CL,Lin LY,Yang JS,et a1.Attenuation of lipopolysaccharideinduced acute lung injury,by treatment with IL-10[J].Respirolo gy,2009,14(4):511-521.
[8]万梅方,顾连兵.单肺通气致急性肺损伤的机制及研究进展[J].国际麻醉学与复苏杂志,2013,34(4):348-351.
[9]唐鸣,巩文怡.咪达唑仑及芬太尼对骨折患者围手术期IL-6/IL-10影响[J].创伤与急危重病医学,2014,2(6):351-354.
[10]谢平,帅训军,艾登斌,等.阿芬太尼对单肺通气患者围术期炎症细胞因子IL-6、IL-10及其m RNA表达的影响[J].中国现代医学杂志,2013,23(11):84-87..
[11]Stephanie L,Andreas W,Jean KH,et al.RNAi screen in apoptotic cancer cell-stimulated human macrophages reveals co-regulation of IL-6/IL-10 expression[J].Immunobiology,2013,281(1):40-51.
[12]Inada T,Yamanouehi Y,Jomura S,et al.Effect of propofol and isoflurane anaesthesia on the immune responsetosurgerym[J].AnaestIlesia,2004,59(10):954-959.
[13]Chow CW,Herrera Abreu biT,Suzuki T,et a 1.Oxidative stress and acute lung injury[J].Am J Respir Cell Mol Biol,2003,29(4):427-431.
[14]Yanwu J,Xin Z,Haibo L,et al.Effects of sevoflurane and propofol on the inflammatory response and pulmonary function of perioperative patients with one lung ventilation[J].Exp Ther Med,2013,6(3):781-785.
[15]Sivrikoz MC,Tuncozgur B,Cekmen M,et al.The role of tissue repefusion in the reexpansion injury of the lungs[J].Eur JCardiothorac Surg,2002,22(5):721-727.
[16]倪剑武,杨涛,张学政,等.七氟烷和异丙酚对单肺通气肺内分流和氧合的影响[J].温州医学院学报,2010,40(3):273-275.
[17]赵晓玲,曾小莉,谢冲,等.丙泊酚或异氟醚麻醉对单肺通气时氧化应激反应的影响[J].临床麻醉学杂志,2010,26(5):376-378.
[18]Sayin MM,Ozatamer O,Tas?z R,et al.Propofol attenuates myocardial lipid peroxide-tion during coronary artery bypass grahing surgery[J].Br J Anaesth,2002,89(5):242-246.