七氟烷对全身麻醉术后肺部感染患者T淋巴细胞及应激水平的影响

Effects of sevoflurane on T lymphocytes and stress levels in patients with pulmonary infection after general anesthesia

目的探讨七氟烷对全身麻醉术后肺部感染患者T淋巴细胞和应激水平的影响。方法选取2017年8月-2018年12月于河南省南阳医专第一附属医院采用全身麻醉手术患者589例为研究对象,采用七氟烷复合瑞芬太尼全身麻醉者307例为研究组,采用丙泊酚复合瑞芬太尼全身麻醉者282例为对照组。观察两组患者T淋巴细胞和应激指标水平,且记录麻醉效果、手术效果、肺部感染率和术后自主呼吸恢复时间、苏醒时间、拔管时间、肛门排气时间。结果两组患者手术成功率、麻醉效果比较,差异无统计学意义;研究组肺部感染率为4.56%(14/307)低于对照组(P=0.047)。麻醉诱导前(T0)、气管插管后5 min(T1)、术中1 h(T2)、术中2 h(T3)、气管导管拔出后30 min(T4),两组患者CD4^+、CD4^+/CD8^+比值及超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-PX)水平均呈现先下降、后升高趋势,去甲肾上腺素(NE)水平呈先升高、后下降(P<0.05);但各时间点研究组CD4^+、CD4^+/CD8^+比值及SOD、CAT、GSH-PX水平均高于对照组、NE水平低于对照组(P<0.05)。研究组术后自主呼吸恢复时间、苏醒时间、拔管时间、肛门排气时间分别为(6.50±2.98)h、(8.90±3.23)h、(11.10±3.01)h、(20.10±4.30)h均短于对照组(P<0.05)。结论七氟烷对全身麻醉手术患者T淋巴细胞和应激水平影响相对较小,利于降低术后肺部感染率,是一种更加优化的麻醉药物,值得扩大样本量多层次、全方位的深入分析其作用机制,为降低麻醉风险、提高手术质量提供参考依据。

OBJECTIVE To investigate the effect of sevoflurane on T lymphocytes and stress levels in patients with pulmonary infection after general anesthesia.METHODS A total of 589 patients underwent general anesthesia in the First Affiliated Hospital of Nanyang Medical College of Henan Province from Aug.2017 to Dec.2018 were enrolled,307 patients with general anesthesia with sevoflurane and remifentanil were selected as observation group,and 282 cases with general anesthesia with propofol combined remifentanil were selected as control group.The levels of T lymphocytes and stress indicators were observed andand anesthetic effect,surgical effect,lung infection rate,postoperative spontaneous breathing recovery time,recovery time,extubation time,and anal exhaust time in two groups were recorded.RESULTS There was no significant difference in the success rate and anesthesia between the two groups.The pulmonary infection rate of the observation group was 4.56%(14/307),significantly lower than that of the control group(P=0.047).Before anesthesia induction(T0),5 min after tracheal intubation(T1),intraoperative 1 h(T2),intraoperative 2 h(T3)and tracheal cathete withdrawal 30 min(T4),the levels of CD4^+,CD4^+/CD8^+and superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-PX)decreased first and then increased,while the levels of norepinephrine(NE)increased first and then decreased(P<0.05).However,the levels of CD4^+,CD4^+/CD8^+and SOD,CAT,GSH-PX in the observation group at each time-point were higher than those in the control group(P<0.05),And the level of NE was significantly lower than that of control group(P<0.05).The recovery time of spontaneous breathing,recovery time,extubation time and anal exhaust time in the study group were(6.50±2.98)h、(8.90±3.23)h、(11.10±3.01)h、(20.10±4.30),respectively,significantly shorter than those in the control group(P<0.05).CONCLUSION Sevoflurane has a relatively small effect on T lymphocyte and stress level in patients undergoing general anesthesia surgery,which is benifical to reduce the postoperative pulmonary infection.Sevoflurane is a more optimized anesthetic drugs.It is worthwhile to expand the sample size,and analyze the mechanism of actions in a multi-level and all-round way o,so as to provide reference for reducing the risk of anesthesia and improving the quality of surgery.