比較極低流量和高流量舒活寧(Desflurane)麻醉對胃切除手術病人細胞激素反應的影響

Comparing the Effects of Minimal Low-flow Desflurane with That of Semi-close High Flow Desflurane on Perioperative Cytokine Response in Patients Undergoing Gastrectomy

背景：麻醉方式的選擇會影響術中細胞激素的反應。我們因此探計極低流量麻醉和高流量半閉鎖循環麻醉對胃切除手術病人細胞激素反應的影響。方法：四十位接受胃切除手術病人隨機分成兩組接受不同麻醉方式，並在不同時間點採血測取腫瘤壞死因子，介白質-6，介白質-8和介白質-1接受器拮抗劑。術中並記錄血流動力狀態，麻藥濃度，使用心血管藥物次數和調動麻藥揮發器的次數。結果：在低流量這組，介白質-8在手術結束的產生比較低，但總量則無統計上的意義。兩組之間的介白質-6，腫瘤壞死因子和介白質-1接受器抗拮劑在整個觀察期間則無差異。使用高流量半閉鎖循環麻醉。這組在術中調動麻藥次數（4比2）和使用心血管藥物次數（10比4）比低流量這組高。結論：本研究顯示低流量和高流量舒活寧麻醉對胃切除手術病人細胞激素的影響是微小的。

Background: Anesthetic techniques may influence the perioperative cytokine response. We investigate two anesthetic techniques: minimal low-flow anesthesia (LFA) and semi-closed high flow anesthesia (HFA) with desflurane on the effect of cytokine response in gastrectomy. Methods: Forty patients scheduled to undergo elective gastrectomy were randomly allocated to LFA (0.3 mL/ min) or HFA (2 L/min) group. Blood was sampled for measurement of tumor necrosis factor (TNF), interleukin (IL)-6, IL-8, and IL-1 receptor antagonist (RA) at scheduled intervals. Hemodynamic responses, desflurane concentrations, numbers of patient using cardiovascular agents, and frequency of vaporizer manipulations were recorded during the operation. Results: For patients in the LFA group, production of IL-8 was significantly less increased at the end of the surgical procedure; however there was no significant difference in total production between groups. There was no significant difference in TNF, IL-6, and IL-1RA production throughout the observed period. The desflurane vaporizer was adjusted more frequently (4 [3-6] versus 2 [1-3] times) for patients in the HFA group, and more patients in this group required the use of cardiovascular agents (10 versus 4) than patients in the LFA group during the operation. Conclusions: The current study demonstrates that smaller increase in cytokine production in the LFA than HFA with desflurane for the patients receiving gastrectomy.