丙泊酚对肺癌切除术患者围术期炎性反应及肺功能的影响

Effects of propofol on perioperative inflammatory response and lung function of patients with lung cancer

目的探讨丙泊酚全凭静脉麻醉与七氟烷单纯吸入麻醉对肺癌患者围术期炎性反应以及肺功能的影响。方法单纯性左肺下叶切除术患者40例,采用随机抽样法分为研究组与对照组各20例。研究组给予丙泊酚全凭静脉麻醉,对照组给予七氟烷单纯吸入麻醉。比较两组麻醉诱导前即刻（T0）、单肺通气开始前即刻（T1）、单肺通气结束前即刻（T2）、手术关胸后即刻（T3）和术后24 h（T4）肺泡-动脉氧分压差（A-a DO2）、呼吸指数（RI）、肺内分流率（Qs/Qt）,以及T0、T3、T4血清基质金属蛋白酶-9（MMP-9）与丙二醛（MDA）浓度。结果两组患者T3～T4时点A-a DO2、RI以及Qs/Qt均较T0明显升高,T3时点MMP-9以及MDA浓度均较T0时点明显上升,差异均有统计学意义（P〈0.05）。研究组T3时点A-a DO2、MMP-9及MDA浓度明显低于对照组,T2～T3期RI明显低于对照组,T1～T3期Qs/Qt明显低于对照组,差异均有统计学意义（P〈0.05）。结论肺癌切除术患者采用丙泊酚麻醉,能够显著降低围手术期间的炎性反应以及过氧化程度,对患者肺功能的损伤较小,值得推广。

Objective To investigate the effect of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on perioperative inflammatory response and lung function in patients with lung cancer.Methods Forty patients with simple resection of lower lobe of left lung were selected in our hospital.They were divided into the study and control groups according to the different anesthesia schemes.The study group was given propofol total intravenous anesthesia while the control group received sevoflurane inhalation anesthesia.Arterial blood samples at the T0（immediately before the induction of anesthesia）,T1（single lung ventilation began immediately before）,T2（single lung ventilation immediately before the end）,T3（operation immediately after the closing chest） and T4（24 h after operation） were collected for blood gas analysis.The alveolar arterial oxygen partial pressure difference（A-a DO2） and respiratory index（RI） and intrapulmonary shunt fraction（Qs/Qt） at T0,T3 and T4were calculated.Meanwhile,serum concentrations of matrix metalloproteinase-9（MMP-9） and malondialdehyde（MDA） were detected.Results Compared with the T0 period,A-a DO2,RI and Qs/Qt at the T3～ T4 periods were increased significantly in the both groups（P〈0.05）.Serum concentrations of MMP-9 and MDA at the T3 period were significantly increased when compared to that at the T0 period（P〈0.05）.The A-DO2 and serum levels of MMP-9and MDA at the T3 period in the study group was obviously lower than that in the control group（P〈0.05）.The RI value at the T2～T3 in the study group was obviously lower than that in the control group（P〈0.05）.The Qs/Qt values at the T1～ T3 period in the study group was obviously lower than that in the control group（P〈0.05）.Conclusion Propofol anesthesia for resection of lung cancer patients can significantly reduce the inflammatory response and peroxidation during perioperative period.It has less injury on pulmonary function.It is worthy of promotion.