靶控输注丙泊酚联合瑞芬太尼对免疫及应激反应的影响

Influence of target controlled infusion with propofol combined with remifentanil on immune and stress reaction

目的探讨靶控输注(TCI)丙泊酚联合瑞芬太尼麻醉方式对直肠癌根治术患者应激反应及细胞免疫功能的影响。方法 TCI丙泊酚联合瑞芬太尼的直肠癌根治术患者60例为A组;单纯TCI丙泊酚40例为B组;C组(26例)静脉泵入丙泊酚0.2～0.6 mg/(kg.h)。比较各组患者生命体征、应激反应、T细胞亚群的分布情况。结果 A组患者在麻醉成功后及手术结束时HR、MAP、SpO2与麻醉前相比均无显著改变,而C组麻醉后有显著改变。A组可保持GLU、COR、IL-6、CRP浓度的稳定,而B组或C组在麻醉和手术过程中呈升高趋势,并且术后恢复较慢。A组T细胞亚群降低的程度低于B组及C组,并且术后细胞免疫恢复功能较快。结论丙泊酚联合瑞芬太尼TCI麻醉能够减少机体的应激反应和对T细胞免疫抑制,是直肠癌根治术的安全可靠的麻醉方式。

Objective To discuss the influence of target controlled infusion（TCI）with propofol combined with remifentanil on the cell immune functions and stress reaction of patients receiving radical resection of rectal carcinoma. Methods Sixty patients receiving TCI with propofol and remifentanil in the radical resection of rectal carcinoma were selected as group A. Those in group B（40 cases ）received simple TCI with propofol. Those in group C （26 ones ）received the injection with 0.2-0.6 mg/（ kg. h）propofol through venous pump. Comparison was made in the vital signs, stress reaction, the distribution of T cell subgroups among the three groups. Results There was no significant difference between the heart rate （HR）, mean arterial pressure （MAP）, arterial oxygen saturation （ SpO2 ） of group A after the anesthesia and during the operation and those before the anesthesia. But those indexes of group C were significantly improved after the anesthesia. The concentration of GLU, COR, IL-6, and COR were stable in group A, but those indexes in group C and B had the tendency of increasing during the anesthesia and operation, and the postoperative recovery was slow. The decreasing degree of T cell subgroups in group A was lower than that in group B and C, and its postoperative recovery of cellular immunity was fast. Conclusion TCI anesthesia with propofol combined with remifentanil can decrease the stress reaction and the inhibition of cellular immunity. It is a safe and reliable anesthetic way for radical resection of rectal carcinoma.