异丙酚和七氟烷麻醉对肺癌切除术患者炎性反应及肺功能的影响

Effects of propofol and sevoflurane anesthesia on inflammation and lung function in patients undergoing lung cancer resection

目的探讨异丙酚和七氟烷麻醉对肺癌切除术患者围术期炎性反应及肺功能的影响。方法选取2016年1月2018年1月间陕西省宝鸡市中医医院收治的111例行肺癌切除术的患者,按照麻醉方案不同分为异丙酚组59例和七氟烷组52例。异丙酚组采用异丙酚+维库溴铵+芬太尼诱导麻醉和异丙酚静脉注射维持麻醉,七氟烷组采用七氟烷+维库溴铵+芬太尼诱导麻醉和七氟烷吸入维持麻醉,比较两组患者相关炎性反应指标和肺功能指标。结果两组患者各时刻心率(HR)、平均动脉压(MAPS)、中心静脉压(CVPS)和心输出量(CO)比较,差异均无统计学意义(均P>0.05)。T3时刻,两组患者血清基质金属蛋白酶-9(MMP-9)和丙二醛(MDA)浓度与组内T0和T4比较,T3时刻组间比较,差异均有统计学意义(均P<0.05)。两组患者T1、T2和T3时刻的肺泡-动脉氧分压差(A-a DO2)、呼吸指数(RI)和肺内分流率(Qs/Qt)均较T0时刻高,且组间T3时刻的A-a DO2、T2和T3时刻的RI及T1、T2和T3时刻的Qs/Qt比较,差异均有统计学意义(均P<0.05)。七氟烷组T3时刻肺动态顺应性(Cdyn)较T1时刻降低,差异有统计学意义(P<0.05)。结论肺癌切除术患者采用异丙酚麻醉,能有效降低围术期炎性反应,对肺功能不会造成较大损害,安全可靠,值得临床推广。

Objective To investigate the effecst of propofol and sevoflurane anesthesia on perioperative inflammatory response in patients undergoing lung cancer resection and its effect on lung function.Methods We selected 111 patients undergoing lung cancer resection who were admitted to Baoji Hospital of Traditional Chinese Medicine from January 2016 to January 2018 to conduct a study.According to the difference in anesthesia protocols,the patients were divided into the propofol group（59 patients） and the sevoflurane group（52 patients）,among which,propofol A total of 59 patients were included in the study.For the group,propofol plus vecuronium bromide and fentanyl-induced anesthesia and propofol intravenous injection were used to maintain anesthesia.For the sevoflurane group,plus vecuronium bromide,fentanylinduced anesthesia and sevoflurane inhalation were used to maintain anesthesia.The relative inflammatory and lung function parameters were compared between the two groups.Results There was no significant difference in heart rate（HR）,mean arterial pressure（MAPS）,central venous pressure（CVPS）,and cardiac output（CO） between the two groups at each time point（P〉0.05）.At the time point of T3,the serum MMP-9（MMP-9） and malondialdehyde（MDA） levels were significantly different from those at T0 and T4（all P〈0.05）.Alveolar arterial oxygen partial pressure difference（A-a DO2）,respiratory index（RI）and pulmonary shunt fraction（Qs/Qt） at the time point of T1,T2 and T3 were higher than at T0.There was a statistically significant difference in A-a DO2 at T3,RI at T2 and T3 and Qs/Qt at T1,T2 and T3 between the groups（all P〈0.05）.The dynamic compliance of lung（Cdyn） was significantly lower at T2 than T1（P〈0.05）.Conclusion Propofol anesthesia can be effectively reduced perioperative inflammatory response without causing greater damage to the pulmonary function in patients undergoing lung cancer resection.It is safe and reliable and worthy of clinical promotion.