Koksal G M, Sayilgan C, Gungor G, Oz H, Sen O, Uzun H, Aydin S
Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. gunizkoksalhotmail.com
Acta Anaesthesiol Scand. 2005 Jul;49(6):835-9. doi: 10.1111/j.1399-6576.2005.00677.x.
This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response.
Sixty ASA I-II patients, scheduled for tympanoplasty, were randomly allocated to be anaesthetized with either sevoflurane or desflurane at maintenance inspiratory concentrations of 1-1.5 MAC of either agent. Blood samples were taken for plasma tumour necrosis factor alpha (TNFalpha), interleukin 1beta and interleukin-6 assay before induction of anaesthesia, before surgery, and at the end of surgery. Alveolar cells were obtained after induction of anaesthesia and at the end of surgery.
Plasma TNFalpha was greater with desflurane than sevoflurane both before surgery (45.1 +/- 3.5 pg ml(-1) for desflurane vs. 23.2 +/- 2.5 pg ml(-1) for sevoflurane, P < 0.01) and (62.0 +/- 5.3 pg ml(-1) vs. 35.5 +/- 4.6 pg ml(-1), P < 0.001). Interleukin 1beta was similarly greater with desflurane than sevoflurane before (39.3 +/- 4.0 pg ml(-1) vs. 17.4 +/- 3.0 pg ml(-1); P < 0.01) and after surgery (46.0 +/- 3.4 pg ml(-1) vs. 23.3 +/- 3.2 pg ml(-1), P < 0.001). There were similar results for interleukin 6 before (42.3 +/- 3.5 pg mls(-1). 29.0 +/- 2.6 pg ml(-1), P < 0.001) and after surgery (86.0 +/- 4.5 pg ml(-1) vs. 45.9 +/- 6.3 pg ml(-1), P < 0.001). Alveolar cell TNFalpha concentrations after surgery were also greater with desflurane than sevoflurane (96.3 +/- 12.4 pg ml(-1) vs. 64.8 +/- 10.1 pg ml(-1), P < 0.001), as were interleukin 1beta (75.4 +/- 6.2 pg ml(-1) vs. 32.0 +/- 8.3 pg ml(-1), P < 0.001) and interleukin 6 concentrations (540.1 +/- 65.3 pg ml(-1) vs. 363.6 +/- 29.2 pg ml(-1), P < 0.001).
Desflurane appears to cause a greater systemic and intrapulmonary pro-inflammatory response than sevoflurane during anaesthesia for ear surgery.
本研究旨在比较七氟烷和地氟烷麻醉对细胞因子反应的影响。
60例拟行鼓室成形术的美国麻醉医师协会（ASA）Ⅰ-Ⅱ级患者，随机分为两组，分别接受七氟烷或地氟烷麻醉，维持吸入浓度为1-1.5倍最低肺泡有效浓度（MAC）。在麻醉诱导前、手术前及手术结束时采集血样，检测血浆肿瘤坏死因子α（TNFα）、白细胞介素1β和白细胞介素-6。在麻醉诱导后及手术结束时获取肺泡细胞。
术前地氟烷组血浆TNFα水平高于七氟烷组（地氟烷组为45.1±3.5 pg/ml，七氟烷组为23.2±2.5 pg/ml，P<0.01），术后同样如此（62.0±5.3 pg/ml对35.5±4.6 pg/ml，P<0.001）。术前地氟烷组白细胞介素1β水平也高于七氟烷组（39.3±4.0 pg/ml对17.4±3.0 pg/ml；P<0.01），术后亦是如此（46.0±3.4 pg/ml对23.3±3.2 pg/ml，P<0.001）。白细胞介素6的结果相似，术前（42.3±3.5 pg/ml对29.0±2.6 pg/ml，P<0.001）及术后（86.0±4.5 pg/ml对45.9±6.3 pg/ml，P<0.001）地氟烷组均高于七氟烷组。术后地氟烷组肺泡细胞TNFα浓度也高于七氟烷组（96.3±12.4 pg/ml对64.8±10.1 pg/ml，P<0.001），白细胞介素1β浓度（75.4±6.2 pg/ml对32.0±8.3 pg/ml，P<0.001）及白细胞介素6浓度（540.1±65.3 pg/ml对363.6±29.2 pg/ml，P<0.001）亦是如此。
在耳部手术麻醉期间，地氟烷似乎比七氟烷引起更强的全身和肺内促炎反应。
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