von Dossow V, Luetz A, Haas A, Sawitzki B, Wernecke K D, Volk H D, Spies C D
Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
J Int Med Res. 2008 Nov-Dec;36(6):1235-47. doi: 10.1177/147323000803600610.
This prospective randomized pilot study compared the influence of fentanyl-based versus remifentanil-based anaesthesia on cytokine responses and expression of the suppressor of cytokine signalling (SOCS)-3 gene following coronary artery bypass graft surgery. Forty patients were assigned to receive anaesthesia with either intravenous remifentanil (0.3 - 0.6 microg/kg per min; n = 20) or intravenous fentanyl (5 - 10 microg/kg per h; n = 20). Levels of interleukin (IL)-6, IL-10, tumour necrosis factor-alpha and interferon-gamma (IFN-gamma) and the expression of SOCS-3 were measured pre- and post-operatively. The data from 33 of the patients were analysed. The IFN-gamma/IL-10 ratio after concanavalin A stimulation in whole blood cells on post-operative day 1 and SOCS-3 gene expression on post-operative day 2 were significantly lower in the remifentanil group than in the fentanyl group. The time in the intensive care unit was also significantly lower in the remifentanil group. These findings suggest that remifentanil can attenuate the exaggerated inflammatory response that occurs after cardiac surgery with cardiopulmonary bypass. Further clinical trials are required to define the influence of choice of intra-operative opioid on post-operative outcome.
这项前瞻性随机对照试验性研究比较了在冠状动脉搭桥手术后，芬太尼麻醉与瑞芬太尼麻醉对细胞因子反应及细胞因子信号转导抑制因子（SOCS）-3基因表达的影响。40例患者被随机分为两组，分别接受静脉注射瑞芬太尼（0.3 - 0.6微克/千克每分钟；n = 20）或静脉注射芬太尼（5 - 10微克/千克每小时；n = 20）进行麻醉。在手术前后分别检测白细胞介素（IL）-6、IL-10、肿瘤坏死因子-α和干扰素-γ（IFN-γ）水平以及SOCS-3的表达。对33例患者的数据进行了分析。结果显示，术后第1天全血细胞经伴刀豆球蛋白A刺激后的IFN-γ/IL-10比值以及术后第2天的SOCS-3基因表达，瑞芬太尼组均显著低于芬太尼组。瑞芬太尼组在重症监护病房的停留时间也显著缩短。这些研究结果表明，瑞芬太尼能够减轻体外循环心脏手术后发生的过度炎症反应。还需要进一步的临床试验来确定术中阿片类药物的选择对术后结果的影响。
