不同麻醉镇静深度BIS闭环靶控输注对腹腔镜胃癌根治术老年患者围术期Th1/Th2平衡的影响

Different Anesthesia and Sedation Depths of BIS-guided Closed-loop Target-controlled Infusion on Perioperative Th1/Th2 Balance in Elderly Patients Undergoing Laparoscopic Radical Gastrectomy

目的探讨BIS闭环靶控输注在不同麻醉镇静深度对腹腔镜胃癌根治术老年患者围术期Th1/Th2平衡的影响。方法对73例择期腹腔镜胃癌根治术的老年患者进行随机数字表法分组,分为BIS闭环靶控输注BIS值55组(H组,36例)和BIS值45组(L组,37例)。分别于手术开始前即刻(T1)、术后2 h(T2)、术后24 h(T3)及72 h(T4)采集静脉血样,流式细胞术微球阵列法测定IL-2、IL-4、IL-6、IL-10、TNF-α和IFN-γ。比较两组患者的手术时间、恢复室停留时间和住院时间。结果与T1比较,T2、T3、T4时H组IL-6、IL-10浓度明显升高(P<0.05),T4时H组IL-4和TNF-α明显升高(P<0.05),T2、T4时H组IL-2、IFN-γ明显升高(P<0.05),T2、T3、T4时L组IL-6、IL-10浓度明显升高(P<0.05),T4时L组IL-2明显降低(P<0.05),T2、T3、T4时H组和L组IFN-γ/IL-6明显降低(P<0.05);与L组比较,T2时H组IL-6、IL-10明显升高(P<0.05),H组IFN-γ/IL-6明显降低(P<0.05),T4时H组IL-2和IL-10明显升高(P<0.05),两组患者的手术时间、恢复室停留时间、住院时间差异均无统计学意义(P>0.05)。结论BIS闭环靶控输注的麻醉镇静深度值45比55更有利于维持胃癌根治术老年患者术后Th1/Th2的平衡状态,但是对于改善患者预后不明显。

Objective To investigate the effect of BIS-guided closed-loop target-controlled infusion on perioperative Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy under different anesthesia and sedation depths.Methods We applied random number table method to divide 73 elderly patients undergoing elective laparoscopic radical gastrectomy into BIS closed-loop target-controlled infusion group with BIS value of 55 (group H,n=36) and BIS value of 45 (group L,n=37).Intravenous blood samples were collected immediately before surgery (T1),2h after surgery (T2),24h after surgery (T3) and 72h after surgery (T4).IL-2,IL-4,IL-6,IL-10,TNF-α and IFN-γ were determined by flow cytometry microsphere array.We compared operation duration,postoperative PACU stay time and postoperative hospitalization time between two groups.Results Compared with T1,IL-6 and IL-10 concentration in group H at T2,T3 and T4 significantly increased (P<0.05),IL-4 and TNF-α in group H at T4 were significantly increased (P<0.05),IL-2 and IFN-γ in group H at T2 and T4 were significantly increased (P<0.05),the concentration of IL-6 and IL-10 in group L at T2,T3 and T4 were increased (P<0.05),IL-2 in group L at T4 was decreased (P<0.05),and IFN-γ/IL-6 in two groups were decreased at T2,T3 and T4 (P<0.05).Compared with group L,IL-6 and IL-10 in group H were significantly increased at T2 (P<0.05),IFN-γ/IL-6 in group H was significantly decreased (P<0.05),IL-2 and IL-10 in group H were significantly increased at T4 (P<0.05).Operation duration,postoperative PACU stay time and postoperative hospitalization time had no statistical significance between two groups (P>0.05).Conclusion The anesthesia and sedation depth of BIS-guided closed-loop target-controlled infusion set at 45 is better than 55 in maintaining Th1/Th2 balance in elderly patients undergoing laparoscopic radical gastrectomy,but it has no obvious effect on long-term prognosis.