CAJ | 학술논문

目的探讨全身麻醉中不同镇静麻醉深度对患者围术期炎性反应的影响.方法择期腹部手术患者40例,年龄48岁～72岁,体重指数22 kg/m2～27 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法,将患者分为2组(每组20例):采用闭环靶控静脉输注(closed-loop target controlled infusion,CLTCI)维持麻醉深度脑电双频指数(bispectral index,BIS)值45组(BIS45组)和采用CLTCI维持麻醉深度BIS值55组(BIS55组).于手术开始前即刻(T1)、术中2 h(T2)、术后24 h(T3)及72 h(T4)时点分别采集静脉血样,采用酶联免疫法测定血浆白细胞介素(interleukin,IL)-6和IL-10浓度. 结果与BIS45组比较,BIS55组T2时血浆IL-6、IL-10浓度分别为(9.8±4.0)ng/L和(8.3±3.6)ng/L,明显升高(P＜0.05),T1、T3、T4时血浆IL-6、IL-10浓度比较,差异无统计学意义(P＞0.05).BIS45组血浆IL-6、IL-10在T2时点分别为(16.4±4.6) ng/L和(16.6±9.2) ng/L,与T1时点血浆IL-6、IL-10浓度[(4.8±2.3)ng/L和(8.6±3.9)ng/L]比较,差异有统计学意义(P＜0.05).BIS55组组内比较,差异均无统计学意义. 结论全麻下择期腹部手术引起的围术期炎症反应,同镇静麻醉深度没有计量相关性;麻醉深度BIS值55同BIS值45比较,对患者围术期炎性反应较轻.
목적 탐토전신마취중불동진정마취심도대환자위술기염성반응적영향.방법 택기복부수술환자40례,년령48세～72세,체중지수22 kg/m2～27 kg/m2,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,채용수궤수자표법,장환자분위2조(매조20례):채용폐배파공정맥수주(closed-loop target controlled infusion,CLTCI)유지마취심도뇌전쌍빈지수(bispectral index,BIS)치45조(BIS45조)화채용CLTCI유지마취심도BIS치55조(BIS55조).우수술개시전즉각(T1)、술중2 h(T2)、술후24 h(T3)급72 h(T4)시점분별채집정맥혈양,채용매련면역법측정혈장백세포개소(interleukin,IL)-6화IL-10농도. 결과 여BIS45조비교,BIS55조T2시혈장IL-6、IL-10농도분별위(9.8±4.0)ng/L화(8.3±3.6)ng/L,명현승고(P＜0.05),T1、T3、T4시혈장IL-6、IL-10농도비교,차이무통계학의의(P＞0.05).BIS45조혈장IL-6、IL-10재T2시점분별위(16.4±4.6) ng/L화(16.6±9.2) ng/L,여T1시점혈장IL-6、IL-10농도[(4.8±2.3)ng/L화(8.6±3.9)ng/L]비교,차이유통계학의의(P＜0.05).BIS55조조내비교,차이균무통계학의의. 결론 전마하택기복부수술인기적위술기염증반응,동진정마취심도몰유계량상관성;마취심도BIS치55동BIS치45비교,대환자위술기염성반응교경.
Objective To investigate the effect of different general anesthesia depth on the perioperative inflammatory reaction.Methods Forty ASA Ⅰ-Ⅱ patients,age range from 48 y to 72 y,with BMI 22 kg/m2-27 kg/m2 were chosed undergoing gastrointestinal surgery.Patients were randomly divided into two groups:group bispectral index (BIS)45,group BIS55 (n=20).Closedloop target controlled infusion (CLTCI) technology was used to maintain different depth of anesthesia.BIS was used for sedation evaluation.Anesthesia was adjusted to achieve a target BIS45 in group BIS45 and 55 in group BIS55.Venous blood samples were collected before surgery (T1)and after the start of the surgery 2 h (T2),24 h (T3) and 72 h (T4) for determination of plasma concentrations of interleukin (IL)-6 and IL-10.Results At T2 time point,in group BIS45 plasma cytokine IL-6 [(9.8±4.0) ng/L] and IL-10[(8.3±3.6) ng/L] values were significantly increased,compared to group BIS55(P=0.048,P=0.005).However,neither IL-6 nor IL-10 was different compared within the two groups at T1,T3,T4 time point.In group BIS45,plasma cytokine IL-6,IL-10 values was significantly increased at T2[(16.4±4.6) ng/L and (16.6±9.2) ng/L],compared to T1 time point[(4.8±2.3) ng/L and (8.6±3.9) ng/L].Conclusions Gastrointestinal surgery with general anesthesia induces inflammatory reaction.This inflammatory response is not "sedation depth-related",and the target BIS55 produces a weaker operative inflammatory response.