七氟烷与丙泊酚对腹腔镜直肠癌根治术患者认知功能、T淋巴细胞及肝功能的影响

目的:探讨七氟烷与丙泊酚对腹腔镜直肠癌根治术患者认知功能、T淋巴细胞水平及肝功能指标的影响。方法:选择2015年6月-2017年8月期间于我院进行腹腔镜直肠癌根治术的110例患者为研究对象,按随机数字表法分为观察组和对照组,每组患者55例。观察组采用丙泊酚静脉全麻方式进行术前麻醉,对照组采用七氟烷吸入全麻方式进行术前麻醉。观察两组患者不同时间点平均动脉压(MAP)、心率(HR)情况,比较两组患者手术前后认知功能、T淋巴细胞水平、肝功能各项指标及不良反应发生情况。结果:两组患者不同时间点MAP、HR组间比较差异无统计学意义(P0.05)。术后6 h、12 h观察组简易精神状态量表(MMSE)评分低于术前,术后6 h、12 h、24 h对照组MMSE评分低于术前和观察组(P0.05)。术后3d两组患者CD3~+、CD4~+、CD4~+/CD8~+水平均降低,CD8~+水平均升高,且观察组CD3~+、CD4~+、CD4~+/CD8~+水平高于对照组,CD8~+水平低于对照组(P0.05)。术后3 d两组患者谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBILI)、直接胆红素(DBILI)水平均升高,但观察组患者各项指标水平低于对照组(P0.05)。观察组不良反应发生率为12.73%,与对照组的7.27%比较差异无统计学意义(P0.05)。结论:七氟烷与丙泊酚在腹腔镜直肠癌根治术中的麻醉效果相当,无严重不良反应发生,但应用丙泊酚进行麻醉对患者术后的认知功能、T淋巴细胞、肝功能指标的影响较小,值得临床推广应用。

Effects of Sevoflurane and Propofol on Cognitive Function, T Lymphocyte and Liver Function in Patients with Laparoscopic Radical Resection of Rectal Cancer

ABSTRACT Objective: To investigate the effects of sevoflurane and propofol on cognitive function, T lymphocyte level and liver function indexes in patients with laparoscopic radical resection of rectal cancer. Methods: 110 patients who were underwent laparoscopic radical resection of rectal cancer in our hospital from June 2015 to August 2017 were selected as research object, and they were randomly divided into the observation group and the control group according to the random number table method, 55 cases in each group. The ob- servation group was anaesthetized by propofol intravenous general anesthesia, the control group was anaesthetized by sevoflurane inhala- tion general anesthesia. The average arterial pressure (MAP) and heart rate (HR) were observed at different time points in the two groups. The cognitive function, T lymphocyte levels, liver function indexes before and after operation and adverse reaction of the two groups were compared. Results: There was no significant difference in MAP and HR between the two groups at different time points(P>0.05).The scores of mini-mental state examination (MMSE) at 6 h and 12 h after operation in the observation group were lower than those be- fore operation, and the MMSE scores in the control group at 6 h, 12 h and 24 h after operation were lower than those before operation and in the observation group (P<0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in two groups at 3d after operation were decreased, and the level of CD8⁺ were increased, the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group were higher than those in the control group, and the level of CD8⁺ was lower than that in the control group (P<0.05). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBILI), direct bilirubin (DBILI) of patients in two groups at 3 d after operation were increased, but the indexes levels of the patients in the observation group was lower than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was 12.73%, and there was no significant difference compared with the 7.27% of the control group (P>0.05). Conclusion: The anesthetic effect of sevoflurane and propofol in laparoscopic radical resection of rectal cancer is the same, and there is no serious adverse reaction. However, the effect of propofol on the postoperative cognitive function, T lymphocyte and liver function indexes is less, which is worthy of clinical application.