Brix-Christensen V, Tønnesen E, Sørensen I J, Bilfinger T V, Sanchez R G, Stefano G B
Department of Anaesthesia and Intensive Care, Aarhus University Hospital, Kommunehospitalet, Aarhus C, Denmark.
Acta Anaesthesiol Scand. 1998 Jan;42(1):63-70. doi: 10.1111/j.1399-6576.1998.tb05082.x.
Cardiac surgery with cardiopulmonary bypass (CPB) evokes a systemic inflammatory response involving the proinflammatory cytokines tumor necrosis factor-alpha (TNFalpha), interleukin (IL)-1, IL-6, IL-8 and anti-inflammatory cytokines such as IL-10. Like IL-10, opioids downregulate the immune responses in vivo and in vitro, including the activity of the cytokine-producing monocytes and granulocytes. The proinflammatory cytokines are potent inducers of the hepatic acute-phase protein synthesis. The aim of the present study was to investigate if choice of anaesthesia, based on high-dose opioids (fentanyl) versus low-dose opioids influenced the release of IL-6, IL-8, and IL-10. Secondly, it was investigated whether serum amyloid P-component (SAP) is an acute-phase protein in man such as C-reactive protein (CRP), with which it is physically and structurally related.
Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either low-dose opioid anaesthesia consisting of thoracic epidural analgesia combined with inhalational anaesthesia (group I) or high-dose fentanyl anaesthesia (group II). From each patient 18 blood samples were taken perioperatively. Cytokine analyses were performed with ELISA, CRP and SAP mere measured with rocket immunoelectrophoresis (RIE).
Surgery and CPB elicited a marked, transient and almost simultaneous proinflammatory and anti-inflammatory cytokine response with no differences between the groups. The cytokine levels returned to preoperative levels 1-3 d after operation. Anaesthesia and surgery did not affect SAP plasma levels while patients showed a major increase in CRP concentrations preceding the cytokine responses.
CABG performed during two different anaesthetic techniques, high-dose fentanyl versus low-dose opioid anaesthesia, elicited a well-defined cytokine response with minor variation in the time course of each cytokine. The cytokine production was not modified by type of anaesthesia. Finally, SAP is not an acute-phase protein in men.
体外循环心脏手术会引发全身炎症反应，涉及促炎细胞因子肿瘤坏死因子-α（TNFα）、白细胞介素（IL）-1、IL-6、IL-8以及抗炎细胞因子如IL-10。与IL-10一样，阿片类药物在体内和体外均可下调免疫反应，包括细胞因子产生单核细胞和粒细胞的活性。促炎细胞因子是肝脏急性期蛋白合成的强效诱导剂。本研究的目的是调查基于高剂量阿片类药物（芬太尼）与低剂量阿片类药物的麻醉选择是否会影响IL-6、IL-8和IL-10的释放。其次，研究血清淀粉样P成分（SAP）是否像C反应蛋白（CRP）一样是人体中的急性期蛋白，二者在物理和结构上相关。
16例行择期冠状动脉旁路移植术（CABG）的患者被随机分为两组，一组接受低剂量阿片类药物麻醉，即胸段硬膜外镇痛联合吸入麻醉（第一组），另一组接受高剂量芬太尼麻醉（第二组）。在围手术期从每位患者采集18份血样。采用酶联免疫吸附测定（ELISA）进行细胞因子分析，采用火箭免疫电泳（RIE）测定CRP和SAP。
手术和体外循环引发了显著、短暂且几乎同时出现的促炎和抗炎细胞因子反应，两组之间无差异。细胞因子水平在术后1 - 3天恢复到术前水平。麻醉和手术不影响SAP血浆水平，而患者在细胞因子反应之前CRP浓度大幅升高。
在两种不同麻醉技术（高剂量芬太尼与低剂量阿片类药物麻醉）下进行的CABG手术引发了明确的细胞因子反应，每种细胞因子的时间进程变化较小。细胞因子的产生不受麻醉类型的影响。最后，SAP不是人体中的急性期蛋白。
