静吸复合麻醉对早期非小细胞肺癌切除术患者应激反应及肺通气功能的影响

Effect of combined static and inhalation anesthesia on stress response and lung function in patients undergoing early NSCLC resection

目的探讨静吸复合麻醉对早期非小细胞肺癌(NSCLC,Non-small-cell carcinoma)切除术患者应激反应及肺功能的影响。方法回顾性分析2015年1月至2016年5月在我院接受诊治80例需要实行早期NSCLC切除术患者进行本次研究,根据麻醉方式不同,将所有患者均分为观察组(n=40)和对照组(n=40),实行切除术时采用静吸复合麻醉进行治疗的为观察组,实行切除术时采用常规静脉麻醉进行治疗的为对照组,对比分析两组采用不同麻醉方式的患者,对早期NSCLC切除术患者的应激反应、肺功能影响。结果两组在T1、T2的Cor、IL-2水平与T0相比,有明显降低,并且A-Ⅱ、IL-10水平则有明显升高,差异有统计学意义(P均<0.05);观察组患者的Cor、IL-2水平在T3、T4有所升高,A-Ⅱ、IL-10水平有所降低,均接近T0时的水平;并且观察组和对照组相比,观察组的变化更为明显,有统计学意义(P均<0.05);观察组的恢复自主呼吸时间、睁眼时间、拔管时间分别为(8.14±1.57)、(20.36±1.74)、(25.41±2.22)min,与对照组相比,各项时间明显更短,有统计学意义(P<0.05);两组在T2时的SaO_2水平比T1有所降低,T3时有所升高,并且观察组低于对照组,差异有统计学意义(P均<0.05);两组在T2时的PaO_2水平有所降低,T3时有所升高,并且观察组与对照组相比显著更低,有统计学意义(P均<0.05);两组在T2的Qs/Qt水平显著升高,T3时稍高于T1,并且观察组高于对照组,有统计学意义(P均<0.05)。结论使用静吸复合麻醉进行早期NSCLC切除术,能减轻患者的应激反应,患者术后清醒时间和拔管时间较短,可有效改善肺的氧合作用,增加肺内分流,能够有效保护围术期患者的肺通气功能,临床价值较高,值得推广应用。

Objective To investigate the effect of combined static and inhalation anesthesia on stress response and lung function in patients with early stage non-small cell carcinoma（ NSCLC） resection. Methods 80 cases needed early NSCLC resection from January 2015 to May 2016 were divided into the observation group（ n = 40） and the control group（ n = 40）. The implementation of resection with combined anesthesia were treated as the observation group,and the implementation of excision of a conventional intravenous anesthesia were treated as the control group. Their influence on stress response and early excision of lung function in patients with NSCLC was comparatively analyzed. Results The levels of Cor and IL-2 decreased significantly at T1 and T2 while compared with T0 in both groups,and the level of A-II and IL-10 increased significantly at T1 and T2（ P〈0. 05）. In the observation group,the levels of Cor and IL-2 increased at T3 and T4,and A-II and IL-10 decreased,which were all close to the level at T0,and the change was more pronounced in the observation group than in the control group（ P〈0. 05）. Their recovered spontaneous breathing time,awake time and extubation time were（ 8. 14 ± 1. 57） min,（ 20. 36 ± 1. 74） min and（ 25. 41 ± 2. 22） min in the observation group,which were all significantly shorter than those in the control group respectively（ P〈0. 05）. The level of SaO_2 and PaO_2 were lower at T2 than at T1,and higher at T3 in both groups,and it was more pronounced in the observation group than in the control group（ P〈0. 05）. The value of Qs/Qt increased significantly at T2,and it was slightly higher at T3 than at T1,and it was obviously higher in the observation group than the control group（ P〈0. 05）. Conclusion The use of intravenous inhalation anesthesia for early NSCLC resection can reduce the patient＇s stress response,postoperative recovery time and extubation time,and it can effectively improve the pulmonary oxygenation,increase intrapulmonary shunt,and protect the pulmonary ventilation function of patients during perioperative period.