| Objectives: To compare the effects of controlled hypotension by remifentanil and nitroprusside on heart rate(HR),mean arterial pressure(MAP),Renin-Angiotensin Ⅱ-Aldosterone System,the quantity of CD3,CD4,CD8 and NK cell,and the level of IL-2,IL-6 and TNF-α in human volunteers undergoing partial hepatectomy.To evaluate the effect of immunosuppression among these.Methods: Forty-two ASA Ⅰ-Ⅱpatients,undergoing partial hepatectomy,were randomized into three groups(14 patients in each group).IV infusion of remifentanil(group R)and nitroprusside(group N)and normal saline(group C)were applied to maintain controlled hypotension,respectively.MAP and HR were measured before induction of anesthesia(T0),immediately before induction of controlled hypotension(T1),5 minutes(T2)and 30 minutes(T3)after controlled hypotension and 20 minutes after termination of controlled hypotension(T4).Plasma levels of renin(PRA),angiotensin(AT-Ⅱ)and aldosterone(ALD)were detected at the same time.The quantity of CD3,CD4,CD8 and NK cell and the level of IL-2,IL-6 and TNF-α were measured before induction of anesthesia(T0),after controlled hypotension half an hour(T3),at the end of surgery(T5),24h(T6)and 72h(T7)after surgery.Results: Both group R and group N are reachable to get a good effect of controlled hypotension.(1)Hemodynamics: At T2 and T3,MAP and HR in group R than the other two groups was significantly lower,and lower than the other time points in group R(P <0.05).HR in group N was significantly higher than the other two groups and the other time points in group N(P <0.05),and that in group C is higher than group R and lower than group N.MAP in group C was higher than group R and group N(P <0.05).At T4,MAP in group N was significantly higher than that in group C and group R(P <0.05),and higher than the other time points in the group N(P <0.05).(2)RAAS system: From T2 to T4,renin and angiotensin Ⅱin group N was significantly higher than the other time points in their own groups,and higher than group R and group C(P <0.05).At T3 and T4,aldosterone in group N was higher than that at T0,T1,T2 in the group N and higher than the other two groups at the same time points(P <0.05).(3)Immunological aspects: At T3 and T5,CD3 and CD8 in group R was significantly lower than that in the group R at the other time points(P <0.05).At T3,CD3 and CD8 in group R was significantly lower than the other two groups,and TNF-α in group N and group C was significantly higher than the other time points in their own groups,and higher than group R(P <0.05).At T5,the levels of CD4 and IL-2 in group R and CD3 in group N and group C were lower than those in group,and the levels of TNF-α in three groups were significantly higher than those in their own groups and that in group N was higher than the others(P <0.05).At T6,T7,three groups of IL-6 were significantly higher than that in the group at the other time points,and group N was higher than the other two groups(P <0.05).Conclusion: Controlled hypotension by remifentanil can be achievable to inhibit the activation of RAAS system,effective to decrease the production of IL-6 and TNF-α,accomplishable to less inhibit the function of T-lymphocyte,which can be eliminated within 24 h after surgery and have no influence on postoperative recovery.Compared with nitroprusside,it owns a better organ protection effect. |
