石崇来,陈敏,邓洁,柯希建
SHI Chonglai,CHEN Min,DENG Jie,KE Xijian

• 1:阳新县人民医院麻醉科
• 2:阳新县第三人民医院麻醉科
• 3:华中科技大学附属同济医院麻醉科

摘要(Abstract)：

目的:探讨七氟烷联合丙泊酚麻醉对腹腔镜全子宫切除患者呼吸力学及血清炎性因子、补体水平的影响。方法:108例行腹腔镜全子宫切除患者均分为实验组和对照组,实验组采用七氟烷联合丙泊酚麻醉,对照组采用舒芬太尼联合丙泊酚复合麻醉;比较2组患者插管后5 min(T1)、建立气腹后5 min(T2)、T体位建立后5 min(T3)、建立气腹后30 min(T4)、解除气腹后5 min(T5)时的气道压(Paw)、气道峰压(PIP)及肺泡动态顺应性(Cdyn);比较术前24 h及术后24 h时2组患者血清白细胞介素-6(IL-6)、IL-10、C反应蛋白(CRP)、C3、C4补体水平,比较手术前后2组患者心率(HR)、血氧饱和度(Sp O2)及平均动脉压(MAP)。结果:T2～T4时点2组患者PIP、Paw均显著高于T1时点,Cdyn明显低于T1时点,实验组Paw显著低于对照组(P <0. 05),T5时点2组患者PIP、Paw、Cdyn均恢复至T1时点水平(P> 0. 05);与术前24 h比较,术后24 h 2组患者血清IL-6、IL-10、CRP水平均显著升高,C3、C4补体水平均显著降低(P <0. 05或P <0. 01),且实验组IL-10水平显著高于对照组,IL-6和CRP水平显著低于对照组(P <0. 05或P <0. 01);术后24 h 2组C3、C4补体水平显著低手术前(P <0. 05或P <0. 01),且对照组显著低于实验组(P <0. 05或P <0. 01);手术前后及组间HR、Sp O2、MAP比较,差异无统计学意义(P> 0. 05)。结论:2种麻醉用药均能有效维持平稳的血流动力学,但七氟烷联合丙泊酚麻醉对行腹腔镜全子宫切除术患者呼吸力学影响相对更小,且能有效减轻炎性反应,平衡CRP和补体水平,且不会产生较大的应激反应。
Objective: To investigate the effects of sevoflurane combined with propofol anesthesia on respiratory mechanics,serum inflammatory factors and complement levels in patients undergoing laparoscopic hysterectomy. Methods: 108 patients undergoing laparoscopic hysterectomy were divided into experimental group( n = 54) and control group( n = 54). The experimental group was anesthetized with sevoflurane and propofol. The control group was treated with sufentanil combined with propofol.Airway pressure( Paw),peak airway pressure( PIP) and alveolar dynamic compliance( Cdyn) were measured at 5 min after intubation( T1),5 min after pneumoperitoneum( T2),5 min after T body establishment( T3),30 min after pneumoperitoneum( T4),and 5 min after pneumoperitoneum( T5).The levels of serum interleukin-6( IL-6),IL-10,C-reactive protein( CRP),C3 and C4 complements were measured at 24 hrs before and after surgery. The heart rate( HR),blood oxygen saturation( SpO2),and mean arterial pressure( MAP) were examined before and after surgery. Results: At the T2 ～ T4 time points,PIP and Paw were significantly higher than those at T1 time point,whereas Cdyn was significantly lower than T1 in both experimental group and control group; Paw in the experimental group was significantly lower than that in the control group( P < 0. 05); at T5 time point,the levels of PIP,Paw and Cdyn restored to those at T1 time point( P > 0. 05); serum IL-6,IL-10 and CRP levels were significantly increased at 24 hours post-surgery when compared with those at 24 hrs before surgery,whereas C3 and C4 complement levels were significantly decreased( P < 0. 05 and P < 0. 01). The level of IL-10 in the experimental group was significantly higher than that in the control group,whereas the levels of IL-6 and CRP were significantly lower than those in the control group( P < 0. 05 and P <0. 01,respectively). After the surgery,the levels of C3 and C4 complements in control group were significantly lower than those in the experimental group( P < 0. 05 and P < 0. 01,respectively); there was no significant difference in HR,Sp O2 and MAP either between the two groups or before and after the surgery( P > 0. 05). Conclusion: Both anesthetics can effectively maintain stable hemodynamics,but sevoflurane combined with propofol has a relatively smaller side effect than sufentanil combined with propofol on patient respiratory mechanics,and can effectively reduce the inflammatory response,balance the levels of CRP and complements without inducing a large stress response.

关键词(KeyWords)： 七氟烷;丙泊酚;麻醉;腹腔镜;全子宫切除术;呼吸力学;炎性因子;补体
sevoflurane;propofol;anesthesia;laparoscopy;total hysterectomy;respiratory mechanics;inflammatory factor;complement

Abstract:

Keywords:

基金项目(Foundation): 荆州市科学技术支撑项目(0982154781)

作者(Author): 石崇来,陈敏,邓洁,柯希建
SHI Chonglai,CHEN Min,DENG Jie,KE Xijian

DOI: 10.19367/j.cnki.1000-2707.2018.12.021

参考文献(References)：

• [1]凌建忠,胡志成,刘号,等.七氟烷或丙泊酚联合舒芬太尼用于腹腔镜手术麻醉效果分析[J].现代诊断与治疗,2012,23(11):1861-1862.
• [2]姜爱华,陈林静,史秀姗,等.不同麻醉方法用于腹腔镜子宫切除术患者的效果[J].中华麻醉学杂志,2012,32(6):121-121.
• [3]朱志峰,徐锦娟,雷超,等.七氟烷联合丙泊酚对非小细胞肺癌胸腔镜切除术后患者血清炎性因子及氧化应激情况的影响[J].中国医院用药评价与分析,2018,18(4):517-521.
• [4]郭红利,张先杰.舒芬太尼与丙泊酚联合麻醉对腹腔镜子宫切除术的效果观察[J].医学信息,2014,7(21):141-142.
• [5]庞晓宏,孔祥国.瑞芬太尼复合异丙酚静脉麻醉100例分析[J].医学争鸣,2009,30(13):1179-1179.
• [6]方俊标,骆晓攀,代乐,等.腹腔镜子宫次全切除术中CO2气腹对肺顺性及肺内血分流的影响[J].现代实用医学,2010,22(12):1343-1345.
• [7]刘印华,卢凌凌,李刚.右美托咪定复合丙泊酚、瑞芬太尼靶控全身麻醉在腹腔镜全子宫切除术中的应用[J].南昌大学学报(医学版),2015,55(5):55-58.
• [8]KARAMAN T,OZSOY A Z,KARAMAN S,et al. The effects of transversus abdominis plane block on analgesic and anesthetic consumption during total abdominal hysterectomy:a randomized controlled study[J]. Revista Brasileira De Anestesiologia,2018,68(3):285-285.
• [9]朱学芳,杜娟,陈金红,等.腹腔镜子宫切除术不同气腹压力下Pa CO2和PETCO2的变化及其相关性[J].临床麻醉学杂志,2015,31(10):1029-1030.
• [10]高项羽,刘喆,吕志峰,等.瑞芬太尼复合丙泊酚静脉麻醉对腹腔镜子宫切除患者呼吸力学的影响[J].河南医学研究,2014,23(9):21-23.
• [11]邵涛,胡海燕.七氟烷和丙泊酚全身麻醉对腹腔镜胆囊切除术中患者血流动力学的影响比较[J].中国药师,2014(9):1529-1531.
• [12]HEDENQVIST P,JENSENWAERN M,FAHLMAN,et al. Intravenous sufentanil-midazolam versus sevoflurane anaesthesia in medetomidine pre-medicated Himalayan rabbits undergoing ovariohysterectomy[J]. Veterinary Anaesthesia&Analgesia,2015,42(4):377-385.
• [13]穆宇新,龚志毅,黄宇光,等.丙泊酚或七氟烷复合瑞芬太尼麻醉对妇科腹腔镜手术病人麻醉苏醒的影响[J].中国医药导刊,2011,13(11):1925-1926.
• [14]SINGH B N,DAHIYA D,BAGARIA D,et al. Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy[J]. Surgical Endoscopy,2015,29(11):3267-3272.
• [15]黄新华,张雅琴,朱慧莉.不同浓度七氟烷联合丙泊酚对腹腔镜子宫切除术患者血清C反应蛋白以及补体变化的研究[J].中国生化药物杂志,2015,35(12):61-63.
• [16]蒋丽,白华,韦妙成,等.子宫肌瘤腹腔镜与开腹切除术围术期TNF-α、IL-6和IL-10的变化[J].中国妇幼保健,2011,26(21):3231-3233.
• [17]林跃芳.传统经腹与腹腔镜胆囊切除术患者创伤应激反应对比观察[J].中国初级卫生保健,2013,27(6):142-143.
• [18]邓超,代志刚,陈咏今,等.七氟烷和丙泊酚麻醉对腹腔镜全子宫切除术患者白细胞介素-6和白细胞介素-10的影响[J].中国医师进修杂志,2013,36(18):23-26.
• [19]张贺,金延武,赵鑫.丙泊酚与七氟烷麻醉时二氧化碳气腹对腹腔镜子宫切除术患者BIS及氧代谢的影响[J].中国生化药物杂志,2017,37(8):142-144.
• [20]TIAN H T,DUAN X H,YANG Y F,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&Pharmacological Sciences,2017,21(23):5515.

文章评论(Comment)：