异丙酚或七氟醚麻醉对肺癌切除术患者围术期炎症反应、肺功能及认知功能的影响。
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Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response, pulmonary function and cognitive function in patients receiving lung cancer resection.
背景与目的
目的是为了探讨异丙酚和七氟醚麻醉对肺癌切除患者炎症反应，肺功能和认知功能的影响及其差异。
方 法
选择2014年1月至2016年1月在济宁市第一人民医院接受肺叶切除术的62例肺癌患者，随机分为两组：异丙酚组（n = 31）和七氟醚组（n = 31）。异丙酚组患者静脉注射异丙酚用于麻醉维持治疗，而七氟醚组患者吸入七氟醚用于麻醉维持。所有患者均由同一操作者进行手术切除。在麻醉诱导（t1）之前，单肺通气前（t2），胸骨闭合术后（t3）和术后24小时（t4）分别记录围手术期患者炎症反应和肺功能的变化。记录两组患者拔管时间，睁眼时间和意识反应恢复时间；采用简易精神状态检查表(MMSE)评估患者认知功能的变化，分别检测麻醉诱导前和术后24h患者血清中S100β蛋白的浓度。
结 果
两组患者在t2和t3时肺泡 - 动脉血氧分压（A-aDO2），呼吸指数（RI）和肺内分流分数（Qs / Qt）的分压差异显著高于t1 (p<0.01)；在t2-t3期间，异丙酚组患者A-aDO2、RI、Qs/Qt显著低于七氟醚组(p<0.05);丙泊酚组患者麻醉诱导后血清白细胞介素-6 (IL-6)、基质金属蛋白酶-9 (MMP-9)水平明显高于t1时，然而白细胞介素-10 (IL-10)水平低于t1时(p<0.01)；在t2-t4期间，异丙酚组患者血清IL-6、MMP-9水平明显低于七氟醚组，而IL-10水平明显高于七氟醚组(p<0.05)。异丙酚组患者术后拔管时间、睁眼时间、反应时间明显短于七氟醚组(p<0.05)。术中至术后24小时异丙酚组患者不良反应发生率明显低于七氟醚组(p<0.05);两组患者在t4时的MMSE评分显著低于在t1，尽管t4时的S100β蛋白的浓度明显高于t1 (p < 0.01);在t4,异丙酚组患者的MMSE评分显著高于七氟醚组,但是S100β蛋白的浓度却低于七氟醚组的患者(p < 0.05)。
结 论
与七氟醚麻醉相比，异丙酚麻醉可显著降低肺癌切除术患者围术期炎症反应，缩短术后恢复时间，保护患者肺功能，改善术后认知功能，降低术中不良反应发生率。
原始文献摘要
Haitao Tian ，Xiuhua Duan，et,al.Effects of propofol or sevoflurane anesthesia on the perioperative inflammatory response,pulmonary function and cognitive function in patients receiving lung cancer resection[J].European Review for Medical and Pharmacological Sciences,2017; 21: 5515-5522
BACKGROUND AND OBJECTIVES:To investigate the effects of propofol and sevoflurane anesthesia on the inflammatory response, pulmonary function and cognitive function of patients undergoing lung cancer resection and their differences.
Methed: 62 patients with lung cancer who underwent pulmonary lobectomy from January 2014 to January 2016 in Jining First People's Hospital were selected and randomly divided into two groups: the propofol group (n=31) and the sevoflurane group (n=31). Patients in the propofol group were treated with intravenous injection of propofol for anesthesia maintenance, whereas those in the sevoflurane group inhaled sevoflurane for anesthesia maintenance. All patients underwent surgical resection of the lobes by the same operator. Changes in the inflammatory response and pulmonary function of patients in the perioperative period were recorded before the induced anesthesia (t1), before one-lung ventilation (t2), after sternal closure by operation (t3) and at 24 h after operation (t4), respectively; the extubation time, eye opening time and response time of two groups of patients were recorded; mini-mental state examination (MMSE) was used to evaluate the changes in cognitive function in patients and detect the concentration of S100 calcium-binding protein β (S100β) in serum of patients before the induced anesthesia and at 24 h after operation, respectively.Results：The difference of partial pressure of alveolar-arterial oxygen (A-aDO2), respiratory index (RI) and intra-pulmonary shunt fraction (Qs/Qt) of two groups of patients at t2 and t3 were significantly higher than those at t1 (p<0.01); during t2-t3, A-aDO2, RI and Qs/Qt of patients in the propofol group were significantly lower than those of patients in the sevoflurane group (p<0.05); the levels of interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) in serum of patients after the induced anesthesia in the propofol group were significantly higher than those at t1, while the level of interleukin-10 (IL-10) was lower than that at t1 (p<0.01); during t2-t4, the levels of IL-6 and MMP-9 in serum of patients in the propofol group were significantly lower than those in patients in the sevoflurane group, while the level of IL-10 was significantly higher than that in patients in the sevoflurane group (p<0.05). The postoperative extubation time, eye opening time and response time of patients in the propofol group were significantly shorter than those of patients in the sevoflurane group (p<0.05). From intraoperative period to 24 h after operation, the prevalence rate of adverse reactions in patients in the propofol group was significantly lower than that in patients in the sevoflurane group (p<0.05); MMSE scores of two groups of patients at t4 were significantly lower than those at t1, while the concentration of S100β was significantly higher than that at t1 (p<0.01); at t4, the MMSE score of patients in the propofol group was significantly higher than that in the sevoflurane group, while the concentration of S100β was lower than that of patients in the sevoflurane group (p<0.05).Conclusion: Compared with sevoflurane anesthesia, propofol anesthesia can significantly reduce the perioperative inflammatory response in patients receiving lung cancer resection, shorten the recovery time after operation, protect the pulmonary function of patients, improve postoperative cognitive function, and reduce the prevalence rate of intraoperative adverse reactions.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
编辑：符校魁 审校：余晓旭