Murphy Glenn S, Szokol Joseph W, Marymont Jesse H, Avram Michael J, Vender Jeffery S
Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Illinois 60201, USA.
Anesth Analg. 2007 Jun;104(6):1334-42, table of contents. doi: 10.1213/01.ane.0000264108.47280.f5.
Experimental data suggest that morphine has unique antiinflammatory properties. We hypothesized that morphine, when compared with fentanyl, would attenuate the perioperative inflammatory response to cardiopulmonary bypass (CPB) when administered as part of a balanced anesthetic technique.
Thirty patients undergoing elective coronary artery bypass graft surgery were randomized to receive, in a double-blind manner, either morphine (40 mg) or fentanyl (1000 microg) as part of a standardized opioid-isoflurane anesthetic. Serum concentrations of interleukin (IL)-6 and IL-8 and expression of neutrophil surface adhesion molecules (CD 11a, CD 11b, CD 11c, and CD 18) were measured perioperatively as indicators of the inflammatory response to surgery. Core temperatures were monitored in the intensive care unit to determine the incidence of postoperative hyperthermia (temperature >38.0 degrees C).
IL-6 and IL-8 concentrations increased in all patients after CPB. The increase in serum IL-6 levels was significantly attenuated in the morphine group compared to the fentanyl group at 3 and 24 h post-CPB (P < 0.05). Reductions in expression of neutrophil adhesion molecules were observed in both groups 15 min and 3 h post-CPB; however, a significantly larger reduction in CD 11b and CD 18 expression was noted in patients receiving morphine (P < 0.05). The incidence of postoperative hyperthermia was more frequent in the fentanyl group (73%) compared to the morphine group (0%, P < 0.05).
Compared with fentanyl, the administration of morphine as part of balanced anesthetic technique suppressed several components the inflammatory response (IL-6, CD 11b, CD 18, postoperative hyperthermia) to cardiac surgery and CPB.
实验数据表明吗啡具有独特的抗炎特性。我们推测，作为平衡麻醉技术的一部分给予时，与芬太尼相比，吗啡会减轻围手术期体外循环（CPB）的炎症反应。
30例行择期冠状动脉搭桥手术的患者被随机双盲接受吗啡（40毫克）或芬太尼（1000微克），作为标准化阿片类药物 - 异氟烷麻醉的一部分。围手术期测量血清白细胞介素（IL）-6和IL-8浓度以及中性粒细胞表面粘附分子（CD 11a、CD 11b、CD 11c和CD 18）的表达，作为手术炎症反应的指标。在重症监护病房监测核心体温，以确定术后高热（体温>38.0摄氏度）的发生率。
CPB后所有患者的IL-6和IL-8浓度均升高。与芬太尼组相比，CPB后3小时和24小时吗啡组血清IL-6水平的升高明显减弱（P < 0.05）。两组在CPB后15分钟和3小时均观察到中性粒细胞粘附分子表达降低；然而，接受吗啡的患者CD 11b和CD 18表达的降低明显更大（P < 0.05）。芬太尼组术后高热的发生率（73%）比吗啡组（0%，P < 0.05）更高。
与芬太尼相比，作为平衡麻醉技术的一部分给予吗啡可抑制心脏手术和CPB炎症反应的几个组成部分（IL-6、CD 11b、CD 18、术后高热）。
