七氟烷与丙泊酚麻醉对腹腔镜胃癌根治术患者认知功能、呼吸循环功能及应激反应影响的比较

Effect comparison of sevoflurane and propofol on cognitive function,respiratory and circulatory function and stress response in patients undergoing laparoscopic radical gastrectomy

目的探讨七氟烷与丙泊酚麻醉对腹腔镜胃癌根治术患者认知功能、呼吸循环功能以及应激反应的影响。方法前瞻性随机对照研究。选取2021年1月至2022年1月凉山彝族自治州中西医结合医院接受腹腔镜胃癌根治术的116例患者,按照随机数字表法分为丙泊酚组和七氟烷组,每组58例,丙泊酚组采用丙泊酚麻醉,七氟烷组采用七氟烷麻醉。比较两组患者麻醉相关指标及不同时间点的呼吸循环功能指标、氧化应激参数、认知功能指标神经元特异性烯醇化酶(NSE)水平和简易智力状态检查(MMSE)量表评分及并发症。结果两组患者基线资料比较,差异均无统计学意义(均P>0.05)。两组患者术中出血量、气腹时间及麻醉起效时间比较,差异均无统计意义(均P>0.05);七氟烷组患者睁眼时间[(13.2±2.6)min比(17.6±3.7)min]及呼吸恢复时间[(12.6±2.2)min比(16.5±2.3)min]均短于丙泊酚组,差异均有统计学意义(t值分别为7.41、9.31,均P<0.001)。重复测量方差分析显示,丙泊酚组和七氟烷组间麻醉诱导前、麻醉诱导后即刻、麻醉持续10 min、麻醉持续20 min、麻醉持续30 min时呼吸循环指标心率、平均动脉压及血氧饱和度比较,时间、组间及时间-组间交互差异均无统计学意义(均P>0.05)。两组间氧化应激指标血糖、肾上腺素、促肾上腺皮质激素、皮质醇在时间、组间及时间-组间交互作用上差异均有统计学意义(均P<0.001),七氟烷组麻醉诱导后即刻、麻醉持续10 min、麻醉持续20 min、麻醉持续30 min时血糖、肾上腺素、促肾上腺皮质激素、皮质醇水平均低于丙泊酚组。丙泊酚组和七氟烷组麻醉前NSE水平分别为(6.6±0.8)ng/ml、(6.5±0.7)ng/ml,差异无统计学意义(P>0.05);七氟烷组NSE水平在术后即刻[(8.9±0.8)ng/ml比(8.2±0.9)ng/ml]、术后6 h[(10.2±1.2)ng/ml比(9.5±1.0)ng/ml]、术后24 h[(9.3±1.1)ng/ml比(8.2±0.9)ng/ml]及术后48 h[(8.7±0.9)ng/ml比(8.1±0.9)ng/ml]均高于丙泊酚组;两组NSE水平在时间、组间及时间-组间交互作用上差异均有统计学意义(均P<0.001)。七氟烷组术后即刻、术后6 h、术后24 h、术后48 h的MMSE量表评分均低于丙泊酚组;两组MMSE量表评分在时间、组间及时间-组间交互作用上差异均有统计学意义(均P<0.001)。丙泊酚组、七氟烷组术后总体并发症的发生率分别为24.1%(14/58)、25.9%(15/58),差异无统计学意义(χ^(2)=2.12,P=0.833)。结论七氟烷与丙泊酚麻醉对腹腔镜胃癌根治术患者的呼吸循环功能均无显著影响,而丙泊酚对认知功能影响更小,七氟烷抑制氧化应激效果更佳,二者均值得临床应用。

Objective To investigate the effect of sevoflurane and propofol on cognitive function,respiratory and circulatory function,and stress response in patients undergoing laparoscopic radical gastrectomy.Methods A prospective randomized controlled study was conducted.A total of 116 patients who underwent laparoscopic radical gastric cancer surgery in Liangshan Yi Autonomous Prefecture Hospital of Integrated Chinese and Western Medicine from January 2021 to January 2022 were selected,and all patients were divided into the propofol group and the sevoflurane group according to the random number table method,with 58 cases in each group.Propofol anesthesia was used in the propofol group and sevoflurane anesthesia was used in the sevoflurane group.The anesthesia-related indexes and respiratory and circulatory function indexes,oxidative stress parameters and cognitive function indexes neuron-specific enolase(NSE)levels,Mini-Mental State Examination(MMSE)scale score,and complications at different time points were compared between the 2 groups.Results There were no statistically significant differences in the baseline data between the 2 groups(all P>0.05).The differences in intraoperative bleeding,pneumoperitoneum time and anesthesia onset time between the 2 groups were not statistically significant(all P>0.05);eye opening time[(13.2±2.6)min vs.(17.6±3.7)min]and respiratory recovery time[(12.6±2.2)min vs.(16.5±2.3)min]of patients in the sevoflurane group were shorter than those in the propofol group,and the differences were statistically significant(t values were 7.41 and 9.31,respectively,both P<0.001).Repeated measurement analysis of variance showed that the temporal,intergroup and temporal-intergroup interaction differences in heart rate,mean arterial pressure and oxygen saturation before induction of anesthesia,immediately after induction of anesthesia,and at the time of anesthesia duration of 10 min,anesthesia duration of 20 min,and anesthesia duration of 30 min between the propofol group and the sevoflurane group were not statistically significant(all P>0.05).The temporal,intergroup and temporal-intergroup interaction differences in the oxidative stress indexes of blood glucose,adrenaline,adrenocorticotropin,and cortisol between the 2 groups were statistically significant(all P<0.001).The levels of blood glucose,epinephrine,adrenocorticotropin and cortisol in the sevoflurane group were lower than those in the propofol group immediately after induction of anesthesia,and at the time of anesthesia duration of 10 min,anesthesia duration of 20 min,and anesthesia duration of 30 min.The level of NSE before anesthesia in the propofol group and the sevoflurane group was(6.6±0.8)ng/ml and(6.5±0.7)ng/ml,respectively,and there was no statistically significant difference(P>0.05).The level of NSE in the sevoflurane group was higher than that in the propofol group immediately after surgery[(8.9±0.8)ng/ml vs.(8.2±0.9)ng/ml],6 h after surgery[(10.2±1.2)ng/ml vs.(9.5±1.0)ng/ml],and 24 h after surgery[(9.3±1.1)ng/ml vs.(8.2±0.9)ng/ml]and 48 h after surgery[(8.7±0.9)ng/ml vs.(8.1±0.9)ng/ml];and there were temporal,intergroup and temporal-intergroup interaction differences in NSE level of the 2 groups(all P<0.001).The MMSE score in the sevoflurane group was lower than that in the propofol group immediately after surgery,6 h after surgery,24 h after surgery,48 h after surgery,the temporal,intergroup and temporal-intergroup interaction differences in MMSE scale score of the 2 groups were statistically significant(all P<0.001).The incidence of postoperative complications in the propofol group and the sevoflurane group was 24.1%(14/58)and 25.9%(15/58),respectively,and the difference was statistically significant(χ^(2)=2.12,P=0.833).Conclusions Sevoflurane and propofol anesthesia have no significant effect on the respiratory and circulatory functions of patients undergoing laparoscopic radical surgery for gastric cancer,whereas propofol has a smaller effect on cognitive functions,and sevoflurane inhibits oxidative stress better.Both of them are worthy of clinical application.