靶控输注麻醉对肾移植患者免疫及应激的影响

Influence of target controlled infusion on immune function and stress response of renal transplantation patients

目的：探讨靶控输注丙泊酚联合瑞芬太尼麻醉方式对肾移植术患者细胞免疫及应激反应的影响。方法76例肾移植患者行靶控输注丙泊酚联合瑞芬太尼麻醉作为 A 组，行静吸复合麻醉的肾移植患者62例作为 B 组。比较两组麻醉前（T0）、麻醉成功后（T1）、术毕时（T2）、术后24 h（T3）、术后72 h（T4）的心率（HR）、动脉血氧饱和度（ SpO2）、平均动脉压（MAP），T 细胞亚群的分布情况，以及血清皮质醇（COR）、白细胞介素-6（IL-6）、C 反应蛋白（CRP）、血糖（GLU）水平。结果A 组 HR 在 T1、T2均分别显著低于 B 组（P ﹤0.05）。T1、T2时 A 组 MAP 显著高于 B 组（P ﹤0.05）。A 组 SpO2在麻醉后各时相与麻醉前相比无显著改变；B 组在 T1、T2均显著低于 T0（P ﹤0.05）。A 组 CD3、CD4、CD8、CD4/ CD8在 T1- T4均分别显著高于 B 组（P ﹤0.05）。A 组 COR、IL-6、CRP、GLU 在 T1、T2、T3、T4较均显著低于 B 组（P ﹤0.05）。结论丙泊酚联合瑞芬太尼靶控输注能够有效地维持血流动力学稳定，减少机体的应激反应和对细胞免疫的抑制，适宜于肾移植术患者的麻醉。

Objective To discuss the influence of target controlled infusion of propofol ＋ remifentanil anesthesia on the cell immune function and stress response of renal transplantation patients. Methods 138 renal transplantation patients were randomly divided into 2 groups：group A（n = 76）and group B（n = 62）;target controlled infusion of propofol ＋ remifentanil anesthesia was performed in group A,while intravenous inhalational anesthesia in group B;a comparative study was made between the 2 groups on heart rate（HR）,mean arterial pressure（MVP）,arterial oxygen saturation（SpO2 ）,and the levels of corticosteroid（COR）,interleukin-6（IL-6）,C-reaction protein（ CRP）,blood glucose（ GLU）at each time point of before anesthesia（ T0）,after anesthesia succeed（ T1）, operation finished（T2）,24 h after operation（T3）,and 72 h after operation（T4）. Results HR in group A at T1 and T2 was obviously lower than that in group B（P ﹤ 0. 05）,while MAP was obviously higher（ P ﹤ 0. 05）;SpO2 in group A at each time point after anesthesia was of no great difference from that at each time point before anesthesia,while SpO2 in group B at T1 and T2 was much lower than that at T0（P ﹤ 0. 05）;COR,IL-6,CRP and GLU in group A at T1,T2,T3 and T4 were much lower than those in group B（P ﹤0. 05）. Conclusions Target controlled infusion of propofol ＋ remifentanil anesthesia can effectively maintain the hemodynamic stability and reduce the stress response and the inhibition of cell immune function,and it is applicable for renal transplantation.