目的 评估舒芬太尼与七氟烷联合后处理对创伤性失血性休克患者炎性反应的影响。方法 成年创伤性失血性休克120例随机分成6组:S组、C1组、C2组在输血前30 min经静脉给予0.1 μg/kg舒芬太尼。S1、C1组与S2、C2组输血前30 min分别吸入0.5 MAC(1MAC=1.7%)及1.0 MAC七氟烷10 min。C组为对照组未行后处理。在给予舒芬太尼前(T0)、给予舒芬太尼后30 min(T1)、七氟烷处理后2 h(T2)和24 h(T3)采血测定TNF-α、IL-6、IL-8、ICAM-1浓度。结果 T2时,S、S2、C1、C2组TNF-α、IL-6、IL-8、ICAM-1浓度较C组差异有统计学意义,并且C2组与其他试验组间差异亦有统计学意义(P＜0.05)。T3时, S2、C1、C2组IL-6浓度较T0和C组差异有统计学意义(P＜0.05); C1、C2组IL-8浓度较C组差异有统计学意义(P＜0.05)。结论 七氟烷舒芬太尼联合后处理通过降低炎性因子的水平,减轻创伤性失血性休克炎性反应,从而发挥脏器保护的作用。

Objective To study the effects of combined sufentanil and sevoflurane postconditioning on inflammatory response in traumatic hemorrhagic shock patients. Methods 120 hemorrhagic shock adult patients for emergency operations on general anesthesia were divided into six groups randomly (n=20). Patients in group S, C1 received sufentanil 0.1 μg/kg intravenously 30 min before blood transfusion; patients in group S1 and C1 received 0.5 MAC sevoflurane for 10 min before blood transfusion; and group S2, C2 received 1 MAC sevoflurane for 10 min before blood transfusion; patients in group C did not receive any postconditioning. Blood samples were taken from radial artery before sufentanil injection(T0), 30 min after sufentanil injection(T1), 2h and 24h after sevoflurane postconditioning(T2, T3) for determination of TNF-α, IL-6, IL-8, and ICAM-1 levels. Results TNF-α, IL-6, IL-8 and ICAM-1 levels in groups S, C1, C2 were different from those in groups C, S1 and S2 at T1(P<0.05). TNF-α, IL-6, IL-8, and ICAM-1 levels in groups S, S2, C1, C2 were different from those in groups C at T2 (P<0.05); and there were significant differences between group C2 and the other test groups (P<0.05). The IL-6 levels in groups S2, C1, C2 were different from group C at T3 (P<0.05), and the IL-8 levels in groups C1 and C2 were different from those in group C (P<0.05). Conclusions Combined sufentanil and sevoflurane postconditioning inhibits inflammatory response by reducing the levels of inflammatory cytokines in traumatic hemorrhagic shock patients, thus protecting their organs.