The Research Of The Balance Of Cytokines Response To Tongue Cancer Surgery During Postoperative Period

Objective:To compare the influence of different aneasthesia methods and different patients controlled intravenous analgesia protocol on pro-inflammatory and anti-inflammatory cytokines response to tongue cancer surgery during postoperative period .Methods:Twenty four adult patients undergone the operation of tongue cancer were assigned to two groups randomly , propofol group(Group P) and isoflurane group(Group I) .In group P anesthesia was induced with fentanyl 2～3μg/ kg, propofol 2 mg/kg,atracurium 0.6 mg/ kg and maintained with propofol 5～8mg·kg-1·h-1 ,inhalation of nirous oxide (N2O:O2 = 50 %:50 %); In group I anesthesia was induced with 3 %～4 % isoflurane ,fentanyl 2～3μg/ kg ,diazopam 2～3mg, atracurium 0.6 mg/ kg and maintained with inhalation of 50 % N2O and isoflurane (ended-tidal isoflurane was maintained at 0. 6 %) , in two groups atracurium was given intermittently .Blood samples were taken from central vein before anesthesia (T0) ,at the end of operation (T1 ) , 24h (T2) and 48h(T3) after operation for determination of serum IL-6 and IL-10 concentrations. Other twenty four adult patients undergone the operation of tongue cancer were assigned to three groups randomly as fentanil group(Group F), fentanil plus lornoxicam group(Group F+L)and control group(Group C) .The anesthesia methods of three groups were same. The analgesic methods of Group F was fentanyl 16μg/kg and Group F+L was fentanyl 8μg/kg and lornoxicam 0.64mg/kg both of them was diluted to 100ml and background 2ml/h.The patients in Group C received traditional analgesia by muscular injection of pethidine while needed. Visual analogue scale (VAS) at 2,12,24,48h after the operation and side effect during the period of PCA were also been recorded .Blood samples were taken from peripheral vein before anesthesia (T0) ,12h (T1 ) , 24h (T2) and 48h(T3) after operation for determination of serum IL-6 and IL-10 concentrations.Results: The IL-6 and IL-10 levels increased significantly in two groups at T1 , T2 and T3 compared with T0 ( P < 0. 01). The increased trend of IL-6 and IL-10 levels were similar in both groups , whereas the level of IL-6 at T1 in propofol group was lower than that of isoflurane group significantly(P<0.01),however the level of IL-10 was much higher in propofol group than that of isoflurane group at T1 and T2(P<0.05) . The VAS score of Group F and Group F+L was much lower than Group C in T1,T2 and T3 (P<0.01);The concentration of IL-6 in Group F and Group F+L was much higher than Group C at T1,T2 and T3(P<0.01);Group F+L was lower than Group F at T1 significantly(P<0.01).however the level of IL-10 in Group F+L was much higher than Group F and Group C at T1,T2(P<0.05).Conclusion:The influence of total intravenous anesthesia of propofol on post-operation inflammatory response is much gentler than isoflurane and maybe has therapeutic potential to prevent severe complication. The patient controlled intravenous analgesia with fentanyl plus lornoxicam has excellent analgesic effect ,which could keep the balance of pro- and anti- inflammatory cytokine and alleviate inflammatory stress and immunology injury.