异丙酚复合瑞芬太尼麻醉对肝癌患者射频消融围术期体征指及相关因子表达的影响

Effect of Propofol Combined with Remifentanil Intravenous Anesthesia on Preoperative Signs and Related Factors in Patients with Liver Cancer during Radiofrequency Ablation

【目的】探讨异丙酚复合瑞芬太尼静脉麻醉对肝癌患者射频消融（RFA）围术期体征指标及血清高迁移率族蛋白B1（HMGB1）、细胞因子的影响。【方法】本院行RFA术治疗的小肝癌患者76例，采用随机数字表法分为异丙酚复合瑞芬太尼组（A组）、异丙酚复合芬太尼组（B组），各38例。比较两组手术情况，记录术前（T。）、RFA开始后5min（F1）、RFA结束（T2）、术后苏醒（T3）点时心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）变化，比较手术前后肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、HMGBl水平。【结果】A组清醒时间短于B组，VAS疼痛评分低于B组（P〈0．05）；两组各时间点Sp02比较差异无显著性（P〉0．05）；与T。燕比较，T1-2时点时两组MAP降低，且A组高于B组；T1-2时点时两组HR降低，且A组低于B组（P〈0．05），其余时间点比较差异无显著性（P〉0.05）；A组术后TNF-α、IL-6、HMGBl低于B组，差异有显著性（P〈0．05）；两组术中并发症发生率比较差异无显著性（P〉0．05）。【结论】异丙酚复合瑞芬太尼静脉麻醉用于肝癌RFA术中麻醉效果确切，且可更好地调节炎性因子，但术中应加强呼吸循环监测。

[Objective]To investigate the effect of propofol combined with remifentanil intravenous anesthesia on signs, serum high-mobility group protein 131 （HMGB1） and cytokines in patients with liver cancer during radiofrequency ablation （RFA）. [Methods]A total of 76 patients with liver cancer treated with RFA in our hospital were divided into the remifentanil combined with propofol group （A group） and fentanyl combined with propofol group （B group） by random, with 38 cases in each group. The recovery time, VAS pain score and incidence rate of intraoperative complications were compared between the two groups. The changes of HR, MAP and SpO2 before operation （To） , at 5 rain after the beginning of RFA （T,）, immediately at the end of RFA （T2） and at recovery （T3） were recorded. The tumor necrosis factor a （TNF- α）, interleukin-6 （IL-6） and HMGBlwere compared before and after operation. [Results]The recovery time of A group was shorter than B group, and the VAS pain score was lower than B group （ P〈0.05）. There was no significant difference in SpO2 between the two groups at different time points （P〈0.05）. Compared to To, MAP of the two groups was lower at T, , and the MAP of A group was higher than B group. From T^2, HR of the two groups decreased, and HR of A group was lower than B group （P〈0.05）. There was no significant difference at other time points （P〈0.05）. TNF-α, 1L-6 and HMGB1 were lower in A group than B group （P〈 0.05）. There was no significant difference in the incidence of complications between the two groups （P〈〉0.05）. [ConclusionlPropofol combined with remifentanil intravenous anesthesia is effective in the anesthesia of RFA for liver cancer. It can better regulate inflammatory factors, ahhough the pseudoalveolus respiratory monitoring is needed during operation.