PDF(Pubmed)
Abstract：
A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients\' general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation.
摘要：
免疫系统减弱和释放更多的炎性细胞因子可能是剖宫产诱导的手术应激的影响。这种反应,除了对儿茶酚胺的反应改变之外，有可能显着影响母亲和患者的免疫系统的一般术后过程。这项前瞻性研究比较了脊髓麻醉与全身麻醉下剖宫产的健康孕妇的血浆儿茶酚胺和细胞因子水平。共有30例接受选择性剖宫产的孕妇分为两组：15例接受全身麻醉（GA）和15例接受脊髓麻醉（SA）。在麻醉诱导前（OP前）从所有受试者中收集血液样本，术后6小时（手术后6小时），和12小时(术后12小时)，测量肿瘤坏死因子-α（TNF-α）的水平，白细胞介素-6（IL-6），IL-8，IL-4，IL-10，去甲肾上腺素（NE），和肾上腺素（EPI）。当我们比较两组时，我们发现，只有IL-6和IL-4有显著较高的前OP水平，而所有研究的细胞因子在OP后6和12小时表现出GA与SA组的增加。在儿茶酚胺的情况下，我们发现血清水平与促炎或抗炎细胞因子呈正相关，取决于一天中的时间和麻醉药物的类型。与SA相比，GA对炎症反应和儿茶酚胺水平具有更一致的作用。这项研究的结果证实，麻醉的类型可以通过改变细胞因子和儿茶酚胺的产生在不同程度上改变术后免疫调节。SA可能是剖宫产的首选，因为它是一种麻醉方法，可以减少围手术期的压力，并减少阿片类药物的使用。通过适当的免疫调节影响细胞因子的产生。
