丙泊酚与七氟醚对胃癌根治术患者免疫功能的影响对比

Comparative Effects Between Propofol and Sevoflurane on Immunological Function in Patients Undergoing Radical Gastrectomy for Gastric Cancer

目的观察并对比丙泊酚与七氟醚对胃癌根治术患者免疫功能的影响。方法选取医院2014年1月至2017年1月收治的行胃癌根治术患者96例,随机分为对照组和观察组,各48例。两组患者均给予常规麻醉诱导(顺苯磺阿曲库铵0.15 mg/kg及枸橼酸舒芬太尼1~2 mg/kg)。在此基础上对照组患者给予2%~3%七氟醚吸入维持麻醉,观察组患者给予4.0~6.0 mg/(kg·h)丙泊酚静脉维持麻醉。分别在麻醉前30 min(T0)、麻醉后1 h(T1)、麻醉后3 h(T2)、术后即刻(T3)、术后24 h(T4)、术后72 h(T5)时检测患者外周血CD4+,CD8+T细胞浓度,在T0和T5时间点检测外周血白细胞介素2(IL-2)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平。对比术后不良反应发生情况。结果随着麻醉时间的延长,两组患者CD4+及CD8+T细胞浓度均呈先减后增趋势,T2至T5,观察组CD4+T细胞增加较对照组明显(P<0.05);T1时,对照组CD8+T细胞增加较观察组明显(P<0.05);T5时,观察组CD4+,CD8+T细胞浓度较T0时无明显差异(P>0.05);两组患者血清CRP,IL-2,TNF-α水平均较T0时降低(P<0.05),且观察组较对照组降低更明显(P<0.05);两组不良反应发生情况比较无明显差异(P>0.05)。结论丙泊酚静脉麻醉在改善胃癌根治术患者免疫功能方面的作用比七氟醚更显著,并可减轻术后炎性反应,值得推广。

Objective To observe and compare the effects between propofol and sevoflurane on immunological function in patients undergoing radical gastrectomy for gastric cancer. Methods Totally 96 patients undergoing radical gastrectomy for gastric cancer admitted to our hospital were selected and randomly divided into the control group and the observation group, 48 cases in each group. All the patients were given conventional anesthesia induction（0. 15 mg/kg cisatracurium besylate and 1-2 mg/kg sufentanil）, on this basis, the control group was given 2% -3% sevoflurane to maintenance the anesthesia, and the observation group was given 4. 0-6.0 mg/（kg.h） propofol to maintenance the anesthesia. The concentrations of CD4＋, CD8＋ T cells in peripheral blood were detected at 30 min before （To） and 1 h（T1）, 3 h（T0） after induction of anesthesia, the end of the operation（T3） and at 24 h（T4）, 72 h（Ts） after operation. The levels of IL-2, TNF- a and CRP were detected at To and Ts. The incidence of postoperative adverse reactions was compared between the two groups. Results With the anesthesia time going, the concentrations of CD4＋, CD8＋ T cells in the two groups were first decreased and then increased（P 〈 0.05）, the concentrations of CD4＋ T cells in the observation group were significantly higher than those in the control group from T to Ts（P 〈 0.05）, the concentration of CD8＋ T cells in the control group were significantly increased than that in the observation group at TI（P 〈 0.05）, the concentrations of CD4＋, CD8＋ T cells at T5 in the observation group was not significantly different from that at To（P 〉 0. 05）. The levels of CRP, IL-2 and TNF- a at T5 in the two groups were decreased than that at To, and the decrease in the observation group was more significant than that in the control group（P 〈 0.05）. There was no significant difference in the incidence of adverse reactions between the two groups（P 〉 0. 05）. Conclusion Intravenous anesthesia of propofol is more effective than sevoflurane in improving the immunological function of patients undergoing radical gastrectomy for gastric cancer, and it can reduce postoperative inflammatot7 reaction, which is worthy of promotion.