不同麻醉下食道癌围术期血浆细胞因子等的变化

目的检测不同麻醉方法下老年患者食道癌手术围术期血浆细胞因子和心肌酶及红细胞糖代谢的变化。方法选择60例无明显心肺疾病的60～75岁的患者。随机分成两组,每组30例。Ⅰ组（实验组）采用静脉气管插管全麻复合连续硬膜外阻滞,Ⅱ组（对照组）采用静脉气管插管全麻。入室后Ⅰ组先行T8-9硬膜穿刺置管。两组都行颈内静脉置管,同时在行桡动脉穿刺置管时、麻醉诱导气管插管后、手术开始后、进入胸腔时、颈段吻合时、关胸时、手术结束时及术后测定白细胞介素-10（IL）浓度及肌酸激酶（CK）,肌酸激酶同工酶（CK-MB）活性。于麻醉前、手术90min、术毕60min、术毕第1天上午8点、术毕第2天上午8点抽取静脉血，测定血糖、红细胞醛糖还原酶（AR）、葡糖6-磷酸果糖（G6PD）、磷酸果糖激酶（PFK）浓度的变化。结果与麻醉前相比，Ⅱ组患者术后第1天血浆MDA浓度及红细胞G-6PD、AR活性显著升高（P〈0．05）；血浆GSH浓度及红细胞PFK活性降低（P〈0．05）。I组以上各参数在术后第1天与麻醉前相比，差异均无统计学意义（P〉0．05）。与麻醉前比较，红细胞G-6PD、AR活性显著升高（P〈0．05），两组患者TNF-α、IL-6、IL-10、CK、CK—MB升高（P〈0．01）。I组与Ⅱ组比较TNF-α、IL-6、IL-10、CK、CK—MB升高（P〈0．01）。结论静脉气管插管全麻联合硬膜外阻滞的麻醉方法减轻手术创伤对红细胞糖代谢和机体氧化应激反应的影响，可抑制炎性反应和心肌缺血再灌注损伤。

The Changes of Perioperation Plasma Cytokines under Different Anesthesia in Patients with Esophageal Cancer

Objective To investigate the changes of plasma cytokines,and the cardiac protease and erythrocyte glycometabolis under different anesthesia.Methods 60 cases of 60-75-year-old patients with no obvious choice of heart and lung diseases were enrolled in this study.They randomly into two groups：Group Ⅰ（experimental group,n=30） were treated with intravenous anesthesia composite continuous epidural anesthesia.Group Ⅱ（control group,n=30） were treated with intravenous anesthesia.After the group Ⅰ in T8-9 epiduralinjection puncturation xianxing catheteration.The two groups will do cariod caphoter.At the same time in a row-Flex when arterial catheterization was performed,after anesthesia induction,the beginning of the operation,the time to open pleusal,Cervical matches,the time to close pleusal,and at the end of the operation and postoperation,IL-10 concentration and creatine kinase（CK）,creatine kinase（CK-MB） activity were assayed.Before surgery,surgery of 90 minutes,up to 60 minutes,surgery on the first day at eight o’clock in the morning,surgery at eight o’clock the next morning,venous blood were collected.Determination of blood glucose,erythrocyte aldose reductase（AR）.the cuprocyanide 6-phosphate to fructose（G6PD）,Phosphofructokinase（PFK） concentrations was performed.Results Compared to before,Group Ⅱ postoperation on day 1 concentration of plasma and erythrocyte G-6PD MDA,AR photocatalystic rise（activity）;the concentration of plasma and red blood cells GSH PFK activity to reduce（P〈0.05）.Group Ⅰ of the above parameters in postoperation on day 1 as compared with before,there was no significant difference（P〉0.05）.And before comparison,erythrocyte G-6PD photocatalystic（activity） of TNF-α,IL-6,IL-10,CK,CK-MB rised（P〈0.01）.Group Ⅰ and II oncogenomic,IL-6,TNF-α,IL-10,CK,CK-MB rised（P〈0.01）.Conclusion Intravenous anesthesia combined with epidural anesthesia treatments can alleviate the damage of surgical trauma on glucose metabolism and oxidative stress response,and inhibit inflammatory response and myocardial ischemia-reperfusion injury.