丙泊酚和七氟醚对胸腔镜手术患者围术期免疫功能和血流动力学的影响  

Effects of propofol and sevoflurane on perioperative immune function and hemodynamics in patients undergoing thoracoscopic surgery

作　　者：姜伟[1,2] 晋小琪 彭卫平 宁新宇 JIANG Wei;JIN Xiaoqi;PENG Weiping;NING Xinyu(Department of Anesthesiology and surgery,The Third Medical Center of PLA General Hospital,Haidian District,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心麻醉手术科,北京100039 [2]解放军总医院第三医学中心军队伤病员管理科,北京100039

出　　处：《中国急救复苏与灾害医学杂志》2021年第7期754-760,共7页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市科技计划课题任务书(编号:Z171100001017149)。

摘　　要：目的研究丙泊酚和七氟醚对胸腔镜手术患者围术期免疫炎症反应和血流动力学的影响。方法选择40例择期在全身麻醉下行胸腔镜肺部疾病手术患者,ASA分级I-III级,随机分为丙泊酚组和七氟醚组各20例。观察组应用丙泊酚全凭静脉麻醉,对照组应用七氟醚吸入麻醉,两组均行超声引导下胸椎旁神经阻滞。两组维持相同的麻醉深度。记录患者入手术室(T0)、切皮时(T1)、单肺通气时(T2)(one-lung ventilation,OLV)、术毕拔管时(T3)心率(heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)、每搏变异度(stroke volume variation,SVV)、心排血量(cardiac output,CO)。还要对比麻醉诱导前(t0)、术后3 h(t1)、术后24 h(t2)、术后72 h(t3)和术后7 d(t4)这几个时间点外周血炎性因子和免疫细胞的变化。比较两组血流动力学、炎性反应、免疫细胞、术后恢复情况和不良反应发生情况。结果①两组患者MAP在T1、T2、T3时间点变化与T0相比无明显变化,差异不具有统计学意义(P>0.05)。两组患者HR、CO在T1、T2、T3时显著高于T0,差异具有统计学意义(P<0.05)。两组患者SVV在T1、T2时与T0相比升高,两组患者手术中MAP无明显变化,相同时间MAP、SVV相比无显著差异,不具有统计学意义(P>0.05)。T3时观察组SVV较T0时升高,差异有统计学意义(P<0.05),对照组HR、CO在T1、T2时与观察组相比较小,差异具有统计学意义(P<0.05)。②与t0时相比,两组患者在T1时血清IL-8、IL-10浓度明显升高(P<0.05);与t0比较,观察组在t1、t2、t3、t4时IL-6浓度明显升高(P<0.05),对照组IL-6浓度在t2、t3、t4时明显升高(P<0.05);与t0时相比,在T2时,两组患者CD4^(+)/CD3^(+)、CD4^(+)/CD8^(+)降低,CD8^(+)/CD3^(+)升高,差异具有统计学意义(P<0.05)。对照组TNF-α浓度在t1、t2、t3、t4时明显小于观察组,具有统计学意义(P<0.05)。两组患者IL-6、CD4^(+)/CD3^(+)、CD4^(+)/CD8^(+)在各时间点相比无明显差异(P>0.05);在t4Objective To investigate the effects of propofol and sevoflurane on perioperative immune inflammatory re‐sponse and Hemodynamics in patients undergoing thoracoscopic surgery.Methods 40 patients undergoing thoracoscop‐ic lung surgery under general anesthesia were randomLy divided into propofol group(n=20)and sevoflurane group(n=20).Total intravenous anesthesia with propofol was used in the observation group,and sevoflurane inhalation anesthe‐sia was used in the control group.Both groups maintained the same depth of anesthesia.heart rate(HR),Mean arterial pressure(MAP),stroke volume variation(SVV),Cardiac output(CO)were recorded at room(T0),skin incision(T1),One-lung ventilation(OLV),extubation(T3),Heart rate(HR),mean arterial pressure(MAP),Stroke Volume Varia‐tion(SVV)and Cardiac output(CO).The changes of inflammatory factors and immune cells in peripheral blood before central venous pres‐induction of anesthesia(t0),3 h(t1),24 h(t2),72 h(t3)and 7 d(t4)were compared.The hemodynamics,inflammato‐ry reaction,immune cells,postoperative recovery and adverse reactions were compared between the two groups.Re⁃sults①compared with T0,the changes of MAP at T1,T2 and T3 time points were not significant(P>0.05).HR AND CO IN T1,T2 and T3 were significantly higher than those in T0,the difference was statistically significant(P<0.05).The level of SVV IN T1 and T2 was higher than that in T0.There was no significant difference in MAP and SVV at the same time between the two groups(P>0.05).The SVV in T3 group was higher than that in T0 group(P<0.05),while HR and Co in control group were lower than that in T1 and T2 Group(P<0.05).②compared with t 0,the levels of IL-8 and IL-10 in t1 were significantly increased(P<0.05);compared with t0,the levels of IL-6 in t1,t2,t3 and t4 were significantly increased(P<0.05),the level of IL-6 in the control group increased significantly at t2,t3 and t4(P<0.05),compared with t0,the level of CD4^(+)/CD3^(+),CD4^(+)/CD8^(+)and CD8^(+)/CD3^(+)increased significantly at T2(P<0.05).The co

关 键 词：丙泊酚 七氟醚 胸腔镜 免疫功能 

分 类 号：R655[医药卫生—外科学]