Hou Bao-Jun, Du Ying, Gu Shu-Xin, Fan Jie, Wang Ran, Deng Hong, Guo Dan-Xia, Wang Li, Wang Yan-Ying
Department of Anesthesiology, Hebei University of Engineering Affiliated Hospital.
Department of Rehabilitation Therapy, Hebei University of Engineering School of Medicine, Handan, Hebei Province, China.
Medicine (Baltimore). 2019 Jul;98(30):e16610. doi: 10.1097/MD.0000000000016610.
The purpose of this study was to investigate the influences of varied anesthetic methods and depths on inflammatory cytokines and stress hormone levels in radical operation among colon cancer patients during perioperative period.A total of 120 patients were collected in the study and randomly divided into 4 groups, A: general anesthesia + Narcotrend D1, B: general anesthesia + Narcotrend D2, C: general anesthesia + epidural anesthesia + Narcotrend D1, D: general anesthesia + epidural anesthesia + Narcotrend D2. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, cortisol (Cor), adrenocorticotropic hormone (ACTH), and endothelin-1 (ET-1) were measured adopting commercial kits before anesthesia (T0), 4 hours after surgery (T1), 24 hours after surgery (T2), and 72 hours after surgery (T3).There was no significant difference in basic clinical characteristics among the groups. In comparison with group A, B and C, group D showed significantly lower levels of TNF-α, IL-6, IL-10, Cor, ACTH, and ET-1 at T1 and T2 (all, P < .05). Significantly higher levels of TNF-α, IL-6, IL-10, Cor, and ACTH were detected at T1 and T2 than those at T0 (all, P < .05), whereas, at T3, the levels of inflammatory cytokines and stress hormones were all decreased near to preoperation ones.General anesthesia combined with epidural anesthesia at Narcotrend D2 depth plays an important role in reducing immune and stress response in patients with colon cancer from surgery to 24 hours after surgery.
本研究旨在探讨不同麻醉方法及深度对结肠癌患者根治性手术围手术期炎症细胞因子和应激激素水平的影响。本研究共纳入120例患者，随机分为4组，A组：全身麻醉+脑电双频指数（Narcotrend）D1；B组：全身麻醉+Narcotrend D2；C组：全身麻醉+硬膜外麻醉+Narcotrend D1；D组：全身麻醉+硬膜外麻醉+Narcotrend D2。采用商用试剂盒于麻醉前（T0）、术后4小时（T1）、术后24小时（T2）及术后72小时（T3）检测肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-10、皮质醇（Cor）、促肾上腺皮质激素（ACTH）及内皮素-1（ET-1）水平。各组间基本临床特征无显著差异。与A组、B组和C组相比，D组在T1和T2时TNF-α、IL-6、IL-10、Cor、ACTH及ET-1水平显著降低（均P<0.05）。T1和T2时TNF-α、IL-6、IL-10、Cor及ACTH水平显著高于T0时（均P<0.05），而在T3时，炎症细胞因子和应激激素水平均降至接近术前水平。全身麻醉联合硬膜外麻醉并维持Narcotrend D2深度，对减轻结肠癌患者手术至术后24小时的免疫和应激反应具有重要作用。
