瑞芬太尼对肺癌手术患者血清IL-6和TNF-α水平的影响-东南大学学报医学版

瑞芬太尼对肺癌手术患者血清IL-6和TNF-α水平的影响

单位：东南大学医学院附属南京胸科医院/南京市胸科医院麻醉科, 江苏南京 210029

分类号：R614;R734.2

出版年·卷·期（页码）：2016·35·第五期（669-672）

摘要：

目的：探讨瑞芬太尼对肺癌手术患者血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平的影响。方法：选择64例择期行肺癌根治术的患者，随机分为瑞芬太尼组（R组）和芬太尼（F组），R组切皮前静脉泵注瑞芬太尼10 μg·kg^-1·h^-1至缝合皮肤时停药，F组持续泵入芬太尼2 μg·kg^-1·h^-1至手术结束前30 min停药，采集两组患者麻醉诱导前（T₀）、切皮后5 min（T₁）、切断支气管时（T₂）和术毕苏醒拔管时（T₃）各时点的静脉血，分析IL-6和TNF-α的水平；记录患者拔管时间及丙泊酚用量。结果：R组患者各时点IL-6水平变化不大，F组T₁、T₂、T₃时点的IL-6水平较R组明显增高（P<0.05）；F组患者T₁、T₂、T₃时点的IL-6水平明显高于T₀时刻（P<0.05）；R组丙泊酚的用量及拔管时间明显少于F组（P<0.05）。两组患者不同时段血清TNF-α变化不大，差异无统计学意义。结论：瑞芬太尼能有效抑制手术创伤引起的IL-6水平升高，减少丙泊酚用量，抑制应激反应。

Objective: To investigate effects of remifentanil on levels of IL-6 and TNF-α in lung carcinoma patients undergoing surgery. Methods: 64 patients who underwent radical resection of lung cancer were randomly divided into remifentanil group(R group) and fentanil group(F group). In group R, 10 μg·kg^-1·h^-1 remifentanil was infused before skin incision till suture of the skin. In group F, fentanil was infused with 2 μg·kg^-1·h^-1 before skin incision and terminated 30 minutes before the surgery. Serum IL-6 and TNF-α were analyzed before induction(T₀), 5 min after incision(T₁), bronchus transection(T₂)and extubation after regaining consciousness(T₃). Extubation time, dosages of propofol were also recorded. Results: In group R, there was no difference in IL-6 at each time point. The level of IL-6 in group F was higher than that of group R significantly at T₁, T₂, T₃(P<0.05). In group F, the level of IL-6 was higher than that of T₀ at T₁, T₂, T₃(P<0.05). The dosage of propofol and extubation time in group R were significantly less than that in group F(P<0.05). Conclusion: Remifentanil could reduce the level of IL-6, the dosage of propofol and inhibit stress reaction in lung carcinoma patients undergoing surgery.

参考文献：

[1] 马雪,侯宝月.曲马多对胸科术后CRP、TNF-α、IL-6和镇痛效果的影响[J].中国现代医学杂志,2011,21(34):4329-4331.
[2] 李秋宏,刘志群,吴论,等.氟比洛芬酯超前镇痛对腹腔镜下直肠癌根治术患者术后镇痛的影响[J].白求恩医学杂志,2015,13(1):32-34.
[3] CHA D G,KIM K S,JEONG J S,et al.The dose effect of ephedrine on the onset time and intubating conditions after cisatracurium administration[J].Korean J Anesthesiol,2014,67(1):26-31.
[4] 张广防,曾朝坤,洪庆雄,等.靶控输注麻醉诱导方式下静脉注射罗库溴铵时的气管插管时机[J].现代医学,2012,40(6):631-635.
[5] HUANG A S,HAJDUK J,JAGANNATHAN N.Advances in supraglottic airway devices for the management of difficult airways in children[J].Expert Rev Med Devices,2016,13(2):157-69.
[6] 蔡兴涛,张中军,刁文波.快通道心脏麻醉对心脏手术患者心肌氧化损伤、炎症反应以及神经相关肽的影响[J].海南医学院学报,2016,22(1):66-68.
[7] 徐震,王卓强,王恒林,等.开胸术后多模式复合镇痛和静脉自控镇痛的疗效及安全性比较[J].中国医药导报,2012,9(31):87-89.
[8] 李晓锋.丙泊酚复合瑞芬太尼静脉麻醉用于开胸手术的效果[J].海南医学,2011,22(1):35-37.
[9] ZHU Y,WANG S,WU H,et al.Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty:a randomized,double-blind,placebo-controlled study[J].Eur J Orthop Surg Traumatol,2014,24(3):395-401.
[10] ZHANG X,HE W,WU X,et al.TCI remifentanil vs TCI propofol for awake fiber-optic intubation with limited topical anesthesia[J].Int J Clin Pharmacol Ther,2012,50(1):10-16.
[11] JANVIER A,MARTINE J L,BARRINGTON K,et al.Anesthetic technique and postoperative outcome in preterm infants undergoing PDA closure[J].J Perinatol,2010,30(10):677-682.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录