Clinical Research About The Effect Of Perioperative Body Temperature Adjusting And Controlling On Cytokine

IntroductionThe human needs to keep the body temperature invariable in order to maintain the need of the normal supersession. The organism maintains the centre temperature in 37.0 ±0.4℃. through body heat regulation system. Generally we regard the centre temperature in 34 - 36 degrees Centigrade as mild hypothermia on clinic. The patient often takes place mild hypothermia because of the anaesthetic , anaesthesia method or exposed in the cold environment during anaesthetizing with the operation. The incidence of mild hypothermia is about 50% -70% for the patients undergoing surgery. Because hypothermia can make the histoor-gan supersession rate reduce, so it often used in the organ protecting such as heart, brain, etc. But it will have more unfavorable impact on the other hand, such as cool response, delay revive after surgery, the function obstacle of blood coagulation and the resistance of infection decrease etc.The change of the patient is comparatively complicated during perioperative period. Many factors such as different surgery, different duration, different anesthesia methods, blood transfusion and neuroendocrine changes may initiate immune changes. The wider the range that even perform the operation and damages of the immune system will change the more obviously. At the same time the anaesthetic will influence immunity of operation to change too. As the same, the hypothermia also can lead immune changes both in the human being and the animal. This has already verified in hypothermia research. Multiple components ofimmune system will be affected when the body is exposed in the cold environment . For example , cell - mediated hypoimmunity, hypoactivity of NK; the number of thymus cells, spleen cells and CD4+ cells are decreased; Suppress B lymphocyte and damage T lymphocyte function, in addition, hypothermia is related to hypoactivity of phagocytes, decrease of products of super oxide anions and bactericidal power.At present, the hypothermia impact on immune function has already a-roused the attention of people gradually. Until now none of relevant report about the mild hypothermia has been known, especially the effect of mild hypothermia on the immune function. In this study we try to find whether to maintain the normal body temperature will decrease post operational immune inhibition through using sandwich ELISA law of one pair of antibodies to monitor the effect of perioperative body temperature adjusting and controlling on cytokine. The study can offer more guidance for anaesthetize and more favorable to the perioperative balance of the immune function and the recovery of patient after operation.Materials and methods1. General materialsThirty patients undergoing neurosurgery by general anesthesia were randomly divided into two groups; hypothermia ( H, n = 15) and warm - up (W, n = 15). ASA Ⅰ - Ⅱ, All of the patients have normal cardiac, hepatic, pulmonary and renal functions. No Infectious disease, Haemolysis disease and high fat blood disease. Have not taken steroids, cytokine and other immune adjust medicine in two weeks before the operation, and does not need blood donor in the operation.2. Anaesthesia methodTwo groups of patient's were intramuscular injection Phenobarbital 0. 1g, Atropine 0. 5mg in 30 minutes before anaesthesia. General anesthesia was induced by Midazolam 2mg, Fentanyl 5μg · kg-1, Propofol 2mg · kg-1, Pipcuro-nium 0.1 mg ·kg-1. Mechanical ventilation started with inhalation 60% N2O after trachea intubation. Fentanyl and Pipcuronium were injected intermittently.Propofol inject use TCI during operation.3. Monitoring methodUseing Detax Ohmeda S/5 monitoring instrument to monitor the noninvasive BP, ECG, SpO2. Write down the crystal, colloidal liquid importing amount, bleeding amount and urine amount during the operation.Temperature of nasopharyngeal (core temperature) and operation room were monitored using Mallinckrodt monitoring instrument of the body temperature. Track record core and operation room temperature at regular intervals of 30min during operation and of 10min after operation.4. Temperature manageHypothermia: Do not exert any intervening measure in the temperature during operation. Patients with core temperature at 34 - 36℃ were included in group H.Warm - up: Patients with forced - air warming system in the trunk to maintain core temperature close to 37℃ were included in group W. Heating from 45min before induction of anesthesia until to the operation over. Infusion fluids were wanned up to 37℃ using fluid warming system before injection.5. Immunity measureBlood samples were taken 1 ml from perpheral vein before anesthesia (T0) and at 24h (T1) ,48h (T2) after operation and kept in EDTA anticoagulation tubes, the serum was taken out after centrifuge and keep on -70℃ for determination of plasm IL -2 and IL - 10 levels using enzyme - linked immunosorbent assay ( ELISA).6. Experiment materialRoutine narcotics and apparatus, Mallinckrodt monitoring instrument of the body temperature, forced - air warming system, IL -2,IL10 kits.7. Statistical analysisThe data were all expressed as mean ± SD . Statistical analysis use paired samples t - test in one group. And use two independent sample t - test in two groups. Statistical analysis were considered significant at P <0.05.