丙泊酚静脉麻醉和七氟醚吸入麻醉对肝癌手术患者麻醉效果、免疫功能的影响研究

The effects of propofol intravenous anesthesia and sevoflurane inhalation anesthesia on the anesthesia effect and immune function in patients undergoing liver cancer surgery

目的比较丙泊酚静脉麻醉和七氟醚吸入麻醉应用于肝癌手术患者的临床效果。方法收集2017年12月至2020年12月收治的92例肝癌患者临床资料,根据不同麻醉方法分为A组44例、B组48例。A组采用丙泊酚静脉麻醉;B组采用七氟醚吸入麻醉。比较两组麻醉效果,分别记录麻醉前30 min、术后1 d两组免疫功能、肝功能、血流动力学指标变化情况,比较两组并发症发生情况。结果A组自主呼吸恢复时间短于B组,清醒程度评分高于B组(P<0.05);两组麻醉前30min、术后1d免疫功能指标CD8^(+)及平均动脉压、心率、氧饱和度及呼吸频率均无显著变化(P>0.05)。术后1d,两组免疫功能指标肿瘤坏死因子-α、C反应蛋白明显上升,CD4^(+)、CD4^(+)/CD8^(+)均降低,肝功能指标丙氨酸氨基转移酶、门冬氨酸氨基转移酶、碱性磷酸酶及总胆红素均较麻醉前30 min上升,且两组间比较,差异均有统计学意义(P<0.05);B组恶心、呕吐发生率高于A组(P<0.05)。结论与七氟醚吸入麻醉比较,丙泊酚静脉麻醉对肝癌手术患者免疫功能影响较小,麻醉效果更佳,但注射痛、呼吸暂停发生率较高,临床可根据患者情况进行选择。

Objective To compare the clinical effects of propofol intravenous anesthesia and sevoflurane inhalation anesthesia in patients with liver cancer surgery.Methods Clinical data of 92 patients with liver cancer from December 2017 to December 2020 were collected.The patients were divided into group A(n=44)and group B(n=48)according to different anesthesia methods.The group A was anesthetized with propofol intravenously while the group B was anesthetized with sevoflurane inhalation.The anesthesia effects of the two groups were compared,and the changes in the immune function,liver function,and physiological indicators of the two groups were recorded at 30 minutes before anesthesia and on the 1 st day after operation.The incidence of complications was also compared between the two groups.Results The recovery time of spontaneous breathing was shorter and the awakeness score was higher in the group A than those in the group B(P<0.05).There was no significant change in the immune function index such as CD8+and physiological indexes at 30 minutes before anesthesia and on the 1 st day after operation,and the mean arterial pressure,heart rate,blood oxygen saturation and respiratory rate between the two groups(P>0.05).On the 1 st day after operation,the immune function indexes such as tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)were significantly increased in both groups,while CD4+,CD4+/CD8+were decreased,the liver function indexes such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and total bilirubin(TBIL)of the two groups were increased when compared with those at 30 minutes before anesthesia.These indexes of the group B were significantly different from those in the group A on the 1 st day after operation(P<0.05).The incidence of nausea and vomiting in the group B was higher than that in the group A(P<0.05).Conclusion Compared with sevoflurane inhalation anesthesia,propofol intravenous anesthesia has less impact on the immune function of patients undergoing liver cancer surgery.The anesthesia effect is better,but the incidence of injection pain and apnea is higher.The clinical choice can be made based on the patient’s own situation.