七氟醚对肝炎肝硬化患者肝癌切除术围术期应激反应及免疫功能的影响

Effect of Sevoflurane on Stress Response and Immune Function During Perioperative Period of Hepatic Carcinectomy in Patients with Liver Cirrhosis

目的探讨七氟醚对肝炎肝硬化患者肝癌切除术围术期应激反应及免疫功能的影响。方法选取2014年12月至2016年12月行肝癌切除术治疗的肝炎肝硬化患者94例,采用回顾性分析法,按照麻醉方法的不同分为对照组(44例)和观察组(50例)。患者麻醉诱导和治疗方法相同,治疗过程中,对照组患者不进行麻醉维持,观察组患者采用七氟醚进行麻醉维持,治疗结束后记录并比较两组患者麻醉诱导开始前即刻(T_0)、手术完毕后即刻(T_1)、术后24 h(T_2)和术后48 h(T_3)的应激反应和免疫功能相关指标水平。结果 T_0时刻,两组患者CD_3^+、CD_4^+/CD_8^+和自然杀伤(NK)细胞百分比,白细胞介素2(IL-2)与白细胞介素10(IL-10)水平比较均无统计学差异(P> 0. 05); T_1和T_2时刻,两组患者CD_3^+和CD_4^+/CD_8^+均明显下降,且对照组下降程度显著大于观察组; T_3时刻,对照组患者CD_3^+、CD_4^+/CD_8^+均低于观察组患者(P <0. 05); T_1时刻,两组患者NK细胞百分比均较T_0时升高,且观察组患者升高程度显著大于对照组患者(P <0. 05); T_1,T_2,T_3时刻,观察组患者IL-2和IL-10水平均无显著变化,但对照组患者T_2和T_3时刻IL-10水平较T_0时显著上升,均显著高于观察组(P <0. 05);两组患者不同时刻的心率和动脉压比较均无统计学差异(P> 0. 05);两组不良反应发生率比较,无明显差异(P> 0. 05),且未发生明显严重不良反应。结论七氟醚可减轻行肝癌切除治疗的肝炎肝硬化患者的应激反应,并对其免疫功能具有一定保护作用。

Objective To investigate the effect of sevoflurane on the stress response and immune function during perioperative period of hepatic carcinectomy in patients with liver cirrhosis. Methods Totally 94 patients with hepatitis cirrhosis undergoing hepatic carcinectomy in our hospital from December 2014 to December 2016 were selected. The clinical data of all patients were analyzed retrospectively.According to different methods of anesthesia,the patients were divided into the control group（ 44 cases） and the observation group（ 50 cases）. The anesthesia induction and treatment were the same for all the patients. During the treatment,the patients in the control group were not maintained with anesthesia,while the patients in the observation group were maintained anesthesia with sevoflurane. At the end of treatment,the stress response and indicators related to immune function were recorded and compared between two groups before the start of anesthesia induction（ T0）,after surgery（ T1）,24 h after surgery（ T2）,and 48 h after surgery（ T3）. Results There was no statistically difference in the CD3^＋,CD4^＋/CD8^＋ and percentages of NK,levels of IL-2 and IL-10 between the two groups at T0（ P〈0. 05）. At T1 and T2,the CD3^＋,CD4^＋/CD8^＋ of the two groups were significantly decreased,and the decrease in the control group was more significant than that in the observation group. At T3,the CD3^＋,CD4^＋/CD8^＋ of the control group were lower than those of the observation group（ P〈0. 05）. At T1,the percentage of NK cells in the two groups was higher than that at T0,and the increase in the observation group was more significant than that in the control group（ P〈0. 05）. At T1,T2 and T3,the levels of IL-2 and IL-10 had no significant change. However,the levels of IL-10 in the control group at T2 and T3 were significantly higher than that at T0,both of which were significantly higher than those in the observation group（ P〈0. 05）. There was no significant difference in heart rate and arterial pressure between the two groups at different time points（ P〉0. 05）. There was no significant difference in the incidence rate of adverse reactions between the two groups（ P〉0. 05）,and no serious adverse reactions occurred. Conclusion Sevoflurane can relieve the stress response of patients with hepatitis cirrhosis undergoing hepatic carcinectomy,and has some protective effect on the immune function of patients.