吸入性七氟烷与丙泊酚复合全麻对腹腔镜子宫切除术患者免疫细胞及纤溶功能的影响

Effects of inhalation sevoflurane and propofol combined with general anesthesia on immune cells and fibrinolytic function in patients undergoing laparoscopic hysterectomy

目的探讨吸入性七氟烷与丙泊酚复合全麻对腹腔镜子宫切除术患者免疫细胞及纤溶功能的影响。方法选取2017年3月至2019年3月西北妇女儿童医院收治的180例腹腔镜子宫切除术患者作为研究对象,依据麻醉方案不同将其分为A组(90例,丙泊酚复合全麻)和B组(90例,吸入性七氟烷复合全麻)。比较两组围手术期免疫细胞(Th1、Th2)、血清激素[皮质醇(Cor)、去甲肾上腺素(NE)]、纤溶功能[组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)]水平及术后认知功能障碍(POCD)发生情况。结果手术结束时(T1)、术后24 h(T2)、术后48 h(T3)时,A组的Th1高于B组,Th2低于B组(P<0.05)。T1、T2、T3时,A组血清Cor、NE水平低于B组(P<0.05)。T1、T2时,A组的t-PA、PAI-1水平低于B组(P<0.05)。术后1、3、7、30 d,A组的POCD发生率低于B组(P<0.05)。结论与吸入性七氟烷复合全麻比较,采用丙泊酚复合全麻对腹腔镜子宫切除术患者的免疫细胞、纤溶功能及血清激素水平影响更小,且能有效降低POCD发生率,具有更高的可行性及安全性。

Objective To investigate the effects of inhalation sevoflurane and propofol combined with general anesthesia on immune cells and fibrinolytic function in patients undergoing laparoscopic hysterectomy.Methods A total of 180 patients with laparoscopic hysterectomy admitted in northwest women’s and children’s hospital from March 2017 to March2019 were selected as the study objects.According to different anesthesia plans,the patients were divided into group A(90 cases,propofol combined with general anesthesia)and group B(90 cases,sevoflurane combined with general anesthesia).The immune cells(Th1,Th2),serum hormone[cortisol(Cor),norepinephrine(NE)],fibrinolytic function[tissue-type plasminogen activator(T-PA),plasminogen activator inhibitor-1(PAI-1)]levels during the perioperative period and the occurrence of postoperative cognitive dysfunction(POCD)in the two groups were compared.Results At the end of operation(T1),24 h after operation(T2)and 48 h after operation(T3),the Th1 in the group A was higher than that in the group B,while the Th2 was lower than that in the group B(P<0.05).At T1,T2 and T3,the serum levels of Cor and NE in the group A were lower than those in the group B(P<0.05).At T1 and T2,the levels of t-PA and PAI-1 in the group A were lower than those in the group B(P<0.05).At 1,3,7,30 d after operation,the incidence of POCD in the group A were lower than that in the group B(P<0.05).Conclusion Compared with inhalation sevoflurane combined with general anesthesia,propofol combined with general anesthesia during laparoscopic hysterectomy has less impact on patients’immune cells,fibrinolysis and serum hormone levels,and it can effectively reduce the incidence of POCD,with higher feasibility and safety.