丙泊酚联合瑞芬太尼静脉麻醉对胃癌患者围术期免疫功能的影响

Effects of Intravenous Anesthesia with Propofol combined with Remifentanil on Perioperative Immune Function in Patients with Gastric Cancer

目的:探讨丙泊酚联合瑞芬太尼静脉麻醉对胃癌患者围术期免疫功能的影响。方法:选取2017年3月至2018年5月我院收治的157例GC根治术患者为研究对象,按照患者就诊顺序编号后采用随机数字表法分为对照组(丙泊酚联合芬太尼静脉麻醉,n=78例)和观察组(丙泊酚联合瑞芬太尼静脉麻醉,n=79)。比较两组麻醉效果、麻醉诱导前后[麻醉诱导前(T1)、麻醉维持60min时(T2)、拔管后10min(T3)]心率(HR)、收缩压(SBP)、舒张压(DBP)、T细胞亚群(CD3^+、CD4^+、CD8^+)水平及药物安全性。结果:观察组麻醉时间、呼之睁眼时间、拔管时间较对照组明显短(P<0.05);与T1相较,T2、T3两组HR、SBP、DBP明显升高,但T2、T3观察组HR、SBP、DBP明显低于对照组,差异有统计学意义(P<0.05);与T1相较,T2、T3两组CD3^+、CD4^+明显降低,CD4^+/CD8^+明显升高,但T2、T3观察组CD3^+、CD4^+、CD4^+/CD8^+明显高于对照组,差异显著(P<0.05);两组不良反应总发生率相较无明显差异(χ2=0.291,P>0.05)。结论:与丙泊酚联合芬太尼静脉麻醉方案相比,丙泊酚联合瑞芬太尼静脉麻醉应用于GC根治术患者中麻醉效果更佳,且可更有效地稳定患者生命体征并减轻围术期免疫抑制。

Objective:To investigate the effects of intravenous anesthesia with propofol combined with remifentanil on perioperative immune function in patients with gastric cancer(GC).Methods:A total of 157 patients undergoing GC radical surgery who were admitted to the hospital from March 2017 to May 2018 were enrolled in the study.They were numbered according to the treatment order and divided into the control group(intravenous anesthesia with propofol combined with fentanyl,n=78)and the observation group(propofol combined with remifentanil intravenous anesthesia,n=79)by the random number table method.The anesthesia effects,heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),T cell subsets(CD3^+,CD4^+,CD8^+)levels and drug safety before and after anesthesia induction[before anesthesia induction(T1),at 60 minutes after anesthesia maintenance(T2),at 10 minutes after extubation(T3)]were compared between the two groups.Results:The anesthesia time,duration of eye opening and extubation time of the observation group were significantly shorter than those of the control group(P<0.05).Compared with those at T1,HR,SBP and DBP at T2 and T3 in both groups were significantly increased.At T2 and T3,HR,SBP and DBP in observation group were significantly lower than those in control group(P<0.05).Compared with those at T1,CD3^+and CD4^+at T2 and T3 in both groups were significantly decreased,while CD4^+/CD8^+was significantly increased.At T2 and T3,CD3^+,CD4^+and CD4^+/CD8^+in the observation group were significantly significantly higher than those in the control group(P<0.05).There was no significant difference in total incidence of adverse reactions between the two groups(χ2=0.291,P>0.05).Conclusion:Compared with propofol combined with fentanyl intravenous anesthesia,the anesthesia effect of propofol combined with remifentanil intravenous anesthesia is better for patients undergoing GC radical surgery,which can more effectively stabilize patients'vital signs,and reduce perioperative immunosuppression.