不同药物联合瑞芬太尼麻醉对食管癌根治术患者炎症反应及肺功能的影响比较

Comparison of Effects of Different Drugs Combined with Remifentanil Anesthesia on Inflammatory Reaction and Pulmonary Function in Patients with Radical Resection of Esophageal Cancer

目的：探讨不同麻醉药物联合使用对单肺通气下行食管癌根治术患者炎症反应及肺功能的影响。方法：选取2014年1月-2015年1月于本院行食管癌根治术患者116例作为研究对象,随机分为丙泊酚组和七氟烷组,每组58例。两组患者均静脉输注瑞芬太尼,丙泊酚组静脉泵注丙泊酚,七氟烷组吸入七氟烷,比较两组患者不同时间点心率（HR）、平均动脉压（MAP）、肺功能指标、核转录因子NF-κB DNA活性及白介素-1（IL-1）水平。结果：两组患者各时间点HR和MAP比较差异均无统计学意义（P〉0.05）;七氟烷组患者在通气后30 min（T2）、60 min（T3）、90 min（T4）时间点的P（A-a）O_2水平较气管插管后5 min（T0）时明显增加（P〈0.05）,两组患者在T2至恢复至双肺通气时（T5）的氧合指数（OI）较T0时明显降低（P〈0.05）,两组患者在T3~T5的呼吸指数（RI）水平较T0时显明显增加（P〈0.05）,丙泊酚组T5、恢复至双肺通气后10 min（T6）、手术结束时（T7）的RI水平明显降低（P〈0.05）,七氟烷组T3、T6、T7时的血浆IL-1水平明显升高（P〈0.05）,丙泊酚组T3、T6、T7的IL-1水平明显低于七氟烷组（P〈0.05）;与T0相比,两组患者的T3、T6、T7时NF-κB DNA活性均升高（P〈0.05）,丙泊酚组T1~T7的NF-κB DNA活性均明显低于七氟烷组（P〈0.05）。结论：单肺通气下行食管癌根治术采用丙泊酚联合瑞芬太尼麻醉对于减轻患者的炎症反应及肺损伤程度的效果更佳。

Objective：To investigate the effects of different anesthetic drugs combination on the inflammatory response and lung function in patients with esophageal cancer after one lung ventilation.Method：From January 2014 to January 2015,116 cases of esophageal cancer radical resection in our hospital were selected as the research objects, they were randomly divided into Propofol group and Sevoflurane group,each group had 58 cases.Two groups were given intravenous infusion of Remifentanil,Propofol group were given intravenous infusion Propofol and sevoflurane group inhaled Sevoflurane,heart rate（HR）,mean arterial pressure（MAP）,pulmonary function,NF-κB transcription factor DNA activity and interleukin-1（IL-1） level of two groups were compared.Result：There were no significant differences in HR and MAP of two groups at each time point（P〉0.05）.Sevoflurane group with P（A -a）O2 level after the ventilation T2,T3,T4 increased than T0 significantly（P〈0.05）,two groups T2 to T5 oxygenation index（OI） reduced than T0 significantly（P〈0.05）,two groups respiratory index（RI） in T3 to T5 increased than T0 significantly （P〈0.05）,Propofol group T5,T6,T7 RI levels were significantly reduced（P〈0.05）,Sevoflurane group T3,T6, T7 plasma IL-1 had obviously higher（P〈0.05）,Propofol group T3,T6,T7 IL-1 levels were Significantly lower than those of Sevoflurane group（P〈0.05）.Compared with T0,two groups T3,T6,T7 NF - kB DNA activity increased （P〈0.05）,Propofol group T1 to T7 NF-κB DNA activity were lower than those of Sevoflurane group（P〈0.05）. Conclusion：The effect of Propofol combined with Remifentanil anesthesia on reducing the degree of lung injury and inflammatory response in patients with lung cancer after one lung ventilation are better.