七氟醚联合瑞芬太尼在肺癌手术患者中的应用  

Effects of sevoflurane combined with remifentanil on stress response and T lymphocyte subsets in patients undergoing lung cancer surgery

作　　者：晋梦彦 张露 高心 JIN Mengyan;ZHANG Lu;GAO Xin(Department of Anesthesiology,Xuchang Hospital of Traditional Chinese Medicine,Xuchang 461000,China)

机构地区：[1]许昌中医院麻醉科,许昌461000

出　　处：《华夏医学》2025年第2期165-170,共6页Acta Medicinae Sinica

基　　金：2020年度河南省医学科技攻关联合共建项目(LHGJ20202433)。

摘　　要：目的探讨七氟醚联合瑞芬太尼在肺癌手术患者中的效果。方法收集137例肺癌手术患者的资料,按照麻醉方案不同分为两组,其中接受七氟醚联合瑞芬太尼麻醉的68例作研究组,接受丙泊酚联合瑞芬太尼麻醉的69例作对照组。比较两组苏醒质量、血流动力学、应激反应、T淋巴细胞亚群、认知功能及不良反应。结果与研究组相比,对照组拔管、自主呼吸恢复、睁眼以及定向力恢复的时间均较长,差异有统计学意义(P<0.05);两组不同时间点平均动脉压相比,无统计学差异(P>0.05),T1、T2时,研究组心率均高于对照组(P<0.05);术后1 d及3 d,与研究组相比,对照组皮质醇、肾上腺素与去甲肾上腺素均较高,CD4^(+)水平、CD4^(+)/CD8^(+)、简易精神状态量表(MMSE)分值均偏低(P<0.05);两组不良反应比较,无统计学差异(P>0.05)。结论七氟醚联合瑞芬太尼用于肺癌手术者,可提高苏醒质量,维持血流动力学稳定,减轻应激反应、免疫抑制,保护认知功能。Objective To investigate the effect of sevoflurane combined with remifentanil in patients undergoing lung cancer surgery.Methods Collect data from 137 lung cancer surgery patients and divide them into two groups according to different anesthesia regimens.Among them,68 patients who received sevoflurane combined with remifentanil anesthesia were selected as the study group,and 69 patients who received propofol combined with remifentanil anesthesia were selected as the control group.Compare the awakening quality,hemodynamics,stress response,T lymphocyte subsets,cognitive function,and adverse reactions between two groups.Results Compared with the study group,the control group had a longer time for extubation,spontaneous breathing recovery,eye opening,and orientation recovery,and the difference was statistically significant(P<0.05).There was no statistically significant difference in mean arterial pressure between the two groups at different time points(P>0.05).At T1 and T2,the heart rate of the study group was higher than that of the control group(P<0.05).On postoperative 1 d and 3 d,compared with the study group,the control group had higher levels of cortisol,adrenaline,and norepinephrine,as well as CD4^(+)levels,CD4^(+)/CD8^(+),the Mini Mental State Examination(MMSE)(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Sevoflurane combined with remifentanil for lung cancer surgery can improve the quality of recovery,maintain hemodynamic stability,alleviate stress reactions and immune suppression,and protect cognitive function.

关 键 词：肺癌 七氟醚 丙泊酚 应激反应 免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]