Effects Of Stress Reaction For Patients With Carcinoma Of Colon During Perioperative Period Under Two Anaesthesia Technics

Background: The stress reaction of perioperative period has became an important subject for study of modern clinical medicine because more and more people suffered from carcinoma of colon need treatment of surgical operation in recent years. The dramatic stress reaction usually causes the serious mess of cytokine and cortisol, interfere with immunity system and lower the existence rate of postoperative patients, and make the risk of the patients undergoing surgical operation increased consumedly. Obviously, this is harmful for the recovery of patients during perioperative period. These patients were in a place of fierce stress reaction before anesthesia which could be enhanced by anesthesia and surgical operation, how to effectively and considerably control the concentration of cytokine and cortisol within the certain range is benefit for the patients to get through perioperative period safely.Researches have proved that cytokine includes two types of pro-inflammatory cytokine and anti-inflammatory cytokine in oppositional quality. They interact with each other and compose important balanceable mechanism of physiology, which is named as cytokine balance. IL-6 and IL-10 are typical representative of these two types of cytokine. Now there is not much more research of the effect of different anesthetic methods on stress reaction about the radical operation for carcinoma of colon. So this experiment adopts radical operation for carcinoma of colon under different anesthetic methods tomeasure the periopetative changes of interleukin-6, interleukin-10 and cortisol, The aim is to investigate the changes trend of interleukin-6, interleukin-10 and cortisol and their connection with stress reaction, to evaluate the influence on stress reaction of the patients of carcinoma of colon undertaking surgical operation under combined epidural-general and total intravenous general anaesthesia. Through this experiment we also wants to select the most effective types of anesthesia for clinical anesthesia which could inhibit the perioperative stress reaction for radical operation of carcinoma of colon.Materials and Methods: Our experiment selected 30 patients (male 22 and female 8), aged(57.84±8.51) years, weight (61.69±4.58) kg, ASA I~II, who have no endocrine and immunity disease, and were suffered from carcinoma of colon and scheduled for the radical operation. All patients were randomly devided into 2 groups (Group EG, G, n=15) and received different anesthetic methods for the operation respectively. Patients in group EG received combined epidural-general anesthesia, in group G received total intravenous general anesthesia. All the general anesthesia was induced with midazolam, vecuronium and fentanyl intravenous, maintained with vecuronium and fentanyl injected respectively when necessary during surgical operation period. In group EG, a epidural catheter was placed cephalad via T\\~\2 or Ti2~Li interspaces before general anesthesia, epidural blockade up to T6 by titrating 0.1% lidocaine combined 0.5% ropivacaine. Blood samples were gathered from subclavicular vein at time of 5 minutes before anesthesia (To), 60 minutes after after surgical incision(Ti), 4 hours after after surgical incision(T2), 24 hours after after surgical incision(T3) and 48 hours after surgical incision (T4). The plasma interleukin-6 and cortisol were measured from To time point to T4 through radioimmunoassay. The plasma interleukin-10 levels were determined from To time to T4 with enzyme- linked immunosorbent assay(ELISA). There was another group (Group H, n=15) of healthy persons received no operation oranesthesia in order to found baseline values of interleukin-6, interleukin-10 and cortisol.Results: (1) The comparison of plasma IL-6, IL-10 and cortisol at To time point between Group EG, G and H: The concentration of IL-6, IL-10 and cortisol in Group EG and G were all higher than that in Group H at To time point, and the difference was statistically significant (IL-6: 155.02+ 17.72pg/ml, 157.45 +20.18pg/ml VS 107.91 + 20.66pg/ml, p<0.01)> (IL-10: 97.13 + 16.97ng/ml, 100.77+14.25ng/ml VS 26.26+ 8.21ng/ml, p<0.01)> (cortisol: 134.70 + 3l.Olng/ml, 144.52 +31.24ng/ml VS 102.23 + 21.93ng/ml, p<0.01). No differences were reported of IL-6, IL-10 and cortisol between Group EG and G (p>0.05).(2) The changes of plasma IL-6 in Group EG and G during perioperative period.Comparison of plasma IL-6 at T2, T3, T4 and T5 time points with Ti time point: The levels of IL-6 gradually increased after anesthesia and beginning of operation on T\, T2and T3 and achieved their maximal value at T3, started to decrease after T3 in 2 groups. (J)In Group EG it was higher at Ti time point than that at To time point, there was statistically significant difference between the two points (155.02+ 17.72pg/ml VS 177.12 +17.88pg/ml, p<0.05). At T2 and T3 time point it was significantly higher than that at To time point (204.58 + 21.99pg/ml, 318.51+27.62pg/ml VS 155.02+17.72pg/ml, p<0.01). There was no statistically difference between T4 and To time point in Group EG (162.84 + 18.35pg/ml VS 155.02+17.72pg/ml, p>0.05). ?It was significantly higher at T|, T2, T3 and T4 time points than that at To time point in Group EG (197.32 + 21.34pg/ml, 282.50 +26.lOpg/ml, 482.33 + 34.70 pg/ml, 231.43+ 24.87pg/ml VS 157.45 +20.18pg/ml,p<0.01).Comparison of IL-6 between 2 groups: The concentration of IL-6 at Ti time point was significantly lower in Group EG than that in Group G (177.12 + 17.88pg/ml VS 197.32 + 21.34pg/ml, p<0.05). The concentration of IL-6 at T2 time point was significantly lower in Group EG than that in Group G (204.58 + 21.99pg/ml VS 282.50 + 26.lOpg/ml, p<0.01). The concentration of IL-6 at T3 time point was significantly lower in Group EG than that in Group G (318.51 + 27.62pg/ml VS 482.33 + 34.70 pg/ml, p<0.01). The concentration of IL-6 at T4 time point was lower in Group EG than that in Group G (162.84+18.35 pg/ml VS 231.43 + 24.87pg/ml, p<0.01).(3) The changes of plasma IL-10 in Group EG and G during perioperative period.Comparison of plasma IL-10 at T|, T2, T3 and T4 time points with T] time point: The levels of IL-10 significantly increased after anesthesia and beginning of operation on Ti and T2 and achieved their maximal value at T2, started to decrease after T2 in 2 groups. ?In Group EG it was higher at Ti time point than that at To time point, but there was no difference between the two points (100.79+ 17.05ng/ml VS 97.13 + 16.97ng/ml, p>0.05). At T2 and T3 time point it was significantly higher than that at To time point (143.28+ 22.24ng/ml, 114.83+17.15 ng/ml VS 97.13+16.97 ng/ml, pO.Ol). It was lower at T4 time point than that at To time point, there was significant difference between the two points(48.57 + 8.49ng/ml VS 97.13 + 16.97ng/ml, p<0.01). (2) It was significantly higher at Ti, T2 and T3 time points than that at To time point in Group EG (116.21+ 15.49ng/ml, 167.37+13.65ng/ml, 138.63 + 16.36ng/ml VS 100.79+ 14.25ng/ml, p<0.01), It was lower at T4 time point than that at To time point, the difference was statistically significant(69.31+8.18ng/ml VS 100.79 + 14.25ng/ml, pO.Ol).Comparison of IL-10 between 2 groups: The levels of IL-10 at Ti time point was significantly lower in Group EG than that in Group G (100.79 + 17.05ng/ml VS 116.21 +15.49ng/ml, p<0.01). The levels of IL-10 at T2 time point was significantly lower in Group EG than that in Group G (143.28 + 22.24ng/ml VS 167.37+ 13.65ng/ml, p<0.01). The levels of IL-10 at T3 time point was significantly lower in Group EG than that in Group G (114.83 + 17.15ng/ml VS 138.63 +16.36ng/ml, p<0.01). The levels of IL-10 at T4 time point was significantly lower in Group EG than that in Group G (48.57 + 8.49ng/mlVS 69.31 + 8.18ng/ml, p<0.01).(4) The changes of plasma cortisol in Group EG and G during perioperative period.Comparison of cortisol at T)5 T2, T3 and T4 time points with To time point: ?The levels of plasma cortisol at Th T2 and T3 time points was significantly higher than that at To time point in Group EG (183.01 +30.62ng/ml, 316.37 + 44.96ng/ml, 242.89+ 39.73ng/ml VS 134. 70+ 31.01 ng/ml, p<0.01). Although it was lower at T4 time point than that at To time point, but there was no significant difference between the two points (127.59+ 30.59ng/ml VS 134.70 + 31.01 ng/ml, p>0.05). ?The levels of plasma cortisol was higher at Tu T2, T3 and T4 time points than that at To time point in Group G, the difference was significant (249.98+ 29.69ng/ml, 383.29 + 44.17 ng/ml, 440.53±47.14ng/ml, 202.12 + 32.47 ng/ml VS 144.52 + 31.24ng/ml, p<0.01).Comparison of cortisol between 2 groups: The level of cortisol in Group EG was much lower than that in Group G at T] T2, T3 and T4 time points, there was significantly difference between them (Ti time point: 183.01+30.62ng/ml VS 249.98 + 29.69ng/ml, pO.Ol; T2time point: 316.37 + 44.96ng/ml VS 383.29 + 44.17ng/ml, p<0.01; T3 time point: 242.89 + 39.73ng/ml VS 440.53 +47.14ng/ml, p<0.01; T4 time point: 127.59 ± 30.59ng/ml VS 202.12 + 32.47ng/ml,p<0.01).Conclusion: ?The fierce stress reaction during perioperative period usually involved every organ and system, causes dramatic changes in concentration of cytokine and cortisol, interfere with immunity system and lower the postoperative existence rate of tumorous patients. ?The patients of carcinoma of colon were associated with fierce stress reaction before surgery, the pro-inflammatory cytokine(IL-6) and anti-inflammatory cytokine(IL-lO) were all obviously higher than the level of normal person, These states contributed to supernormal growth of tumorous cells, this experiment proved that the changes of IL-6 and cortisol could represent the degree of stress reaction. (3)It is important for anesthetic effect to control the levels of stress reaction, to holding the stabilization of internal environment. ?Different anesthesia methods have different effects on the stress reaction and interleukine levels of patients. General anesthesia is demonstrated to have no use for activating traumatic stress reaction during operation.however, combined epidural and general anaesthesia can alleviate stress reaction obviously, and its effects will be even better when combined with postoperative analgesia, especially in the patient with carcinoma.