丙泊酚复合七氟醚用于胃癌根治术的麻醉效果及机制探讨

Anesthesia Effects of Propofol Combined with Sevoflurane on the Patients with Radical Gastrectomy and Its Mechanism

目的:探讨丙泊酚复合七氟醚用于胃癌根治术患者的麻醉效果及可能机制。方法:选取2015年7月-2017年8月拟在我院择期行胃癌根治术患者89例,根据入院顺序编号采用奇偶数法分为对照组和观察组,对照组(44例)给予依托咪酯麻醉,观察组(45例)给予丙泊酚复合七氟醚。比较两组麻醉前后生命体征、免疫功能指标的变化,麻醉效果,术后苏醒质量及不良反应的发生情况。结果:麻醉前,两组患者SBP(Systolic blood pressure,收缩压)、DBP(Diastole pressure,舒张压)、HR(Heart rate,心率)、SPO_2(oxyhemoglobin saturation,血氧饱和度)水平比较差异无统计学意义(P>0.05);麻醉后,两组患者SBP、DBP、HR水平均比麻醉前显著降低(P<0.05),而SPO_2均显著高于麻醉前,两组之间以上指标的差异无统计学意义(P>0.05)。观察组的麻醉效果明显优于对照组(P<0.05),术后睁眼时间、拔管时间及定向力恢复时间均显著少于对照组(P<0.05)。麻醉前,两组患者CD3^+(CD3^+Prioritisation,CD3^+比例)、CD4^+(CD4^+Prioritisation,CD4^+比例,CD8^+(CD8^+Prioritisation,CD8^+比例)及CD4^+/CD8^+值之间比较差异无统计学意义(P>0.05);两组患者手术结束时的以上指标均显著低于麻醉前(P<0.05),手术结束24 h后,观察组CD3^+、CD4^+及CD4^+/CD8^+值恢复至麻醉前水平(P>0.05),而对照组仍低于麻醉前水平(P<0.05)。观察组不良反应的发生率显著低于对照组(P<0.05)。结论:丙泊酚复合七氟醚对于胃癌根治术患者麻醉效果好、术后苏醒质量高,可能与患者术后免疫功能恢复快有关。

Objective： To explore the effect of propofol combined with sevoflurane on the anesthesia in patients with radical gastrectomy and its possible mechanisms. Methods： 89 cases of patients in our hospital for radical gastrectomy from July 2015 to August2017 were selected. According to the admission order number, all the patients were divided into the control group and the observation group by odd and even method. The control group（44 cases） was given etomidate anesthesia, the observation group（45 cases） given propofol combined with sevoflurane. The changes of quality of life, immune function before and after anesthesia, effect of anesthesia,postoperative recovery, and occurrence of adverse reactions were compared between the two groups. Results： There was no statistically significant differences in the SBP, DBP, HR and SPO_2 between the two groups before anesthesia（P0.05）. After anesthesia, the SBP,DBP, HR were all lower obviously than those before anesthesia, while the SPO_2 were all higher than those before anesthesia, which showed no significant difference（P〈0.05）. The anesthesia effect of observation group was significantly better than that of the control group（P0.05）. The eye opening time, removal time and orientation time were significantly shorter in the observation group than those of the control group（P0.05）. There was no statistically significant differences in the CD3~＋, CD4~＋, CD8~＋and CD4~＋/CD8~＋between the two groups before anesthesia（P0.05）. At the end of the operation, the indexes of the two groups were significantly lower than those before the anesthesia（P0.05）. At 24 h after operation, the levels of CD3~＋, CD4~＋and CD4~＋/CD8~＋in the observation group restored to anesthesia level（P〈0.05）, while the control group was still lower than the anesthesia level（P〈0.05）. The incidence of adverse reactions in the observation group was significantly lower than that in the control group（P0.05）. Conclusions： Propofol combined with sevoflurane had a good anesthesia effect on the patients with radical gastrectomy, and it may be related to the recovery of immune function.