摘要
目的 研究开胸食管癌手术患者围术期的细胞因子变化与术后并发症的关系。方法择期食管癌手术患者25例,按有无并发症发生分为A、B两组。B组入选患者包括肺部感染2例、胸腔积液3例、吻合口出血1例、心律失常2例。监测麻醉前（T0）、手术开始切皮时（T1）、进胸后2h（T2）、鼓肺后 60min（T3）、术后 1h（T4）、术后 6h（T5）、术后24h（T6）血清IL-6、IL-8、IL-10的浓度。观察围术期血流动力学变化及全身性炎症反应综合征（SIRS）的持续时间（SIRS为ACCP/SCCM标准）。结果 两组患者围术期的血液动力学变化相似,SIRS持续时间A组少于B组。进胸后各时点IL-6、IL-8、IL-10均较术前显著增加（P<0.01）,T4达到高峰后回落;IL-6组间T2-T5比较无显著差异,T6B组较A组明显上升（P<0.01）,B组IL-8T3至 T6均较A组显著上升（P<0.05或0.01）。IL-10的变化趋势与IL-6、IL-8一致,在T4达到峰值后回落,B组术中各时点IL-10水平与A组比较无显著性差异,T6时低于A组。A组IL-6/IL-10、IL-8/IL-10比值在T5、T6时显著低于B组（P<0.01）。结论 开胸食管癌手术患者术后并发症的发生,不仅是由于炎症介质的大量产生,更在于抗炎性介质的不足。围术期IL-6/IL-10、IL-8/IL-10比值对于判断预后具有一定的价值。
Objective To examine the relationship between the perioperative changes in cytokines and the postoperative complications after esophagecotomy. Methods Twenty-five ASA Ⅱ-Ⅲ patients undergoing esophagectomy were divided into two groups: group A without postoperative complication (n = 17), group B with postoperative complications including pulmonary infection (in 2 patients), pleural effusion (in 3 patients), cardiac arrhythmia(in 2 patients) and anastomosis hemorrage(in 1 patient) (n = 8). Blood samples were taken before anesthesia(T0 ), at skin incision(T1), 2h after chest was opened(T2 ), 60 min after lungs were inflated (T3) and 1,4, 24h after surgery (T4, T5, T6 ) for determination of serum IL-6, IL-8 and IL-10 concentrations. The durations of SIRS, the definition of which was set by American College of Chest Physicians /Society of Critical Care Medicine (ACCP/SCCM), was also recorded. Results The demographic data including age, sex and body weight were comparable between the two groups. There was also no significant difference in preoperative lung function, duration of surgery, blood loss during surgery and duration of unilateral lung ventilation between the two groups. The duration of SIRS was shorter in group A than that in group B. In both groups serum IL-6 and IL-8 levels increased significantly at T2 (after thoracotomy) reached their peak values at T4, and then gradually declined but were still significantly higher than the baseline values(T0). The serum IL-6 level was significantly higher at T6 (24h after surgery) in group B than that in group A. The serum IL-8 level was significantly higher at T3-6 in group B than that in group A. The IL-6/IL-10 and IL-8/IL-10 ratio were significantly lower at T5-6 in group A than those in group B. Conclusions The postoperative complications may occur due to the inflammatory response, and/or anti-inflammatory mediators insufficiency. The IL-6/IL-10 and IL-8/IL-10ratio may be of value in predicting the prognosis.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2002年第8期456-458,共3页
Chinese Journal of Anesthesiology
