贵州医科大学学报

2018, v.43;No.219(12) 1466-1470

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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与补体的影响
Effects of Sevoflurane Combined with Propofol Anesthesia on Respiratory Mechanics,Serum Inflammatory Factors and Complement Levels in Patients Undergoing Laparoscopic Hysterectomy

石崇来;陈敏;邓洁;柯希建;
SHI Chonglai;CHEN Min;DENG Jie;KE Xijian;Department of Anesthesiology,People's Hospital of Yangxin County;Department of Anesthesiology,The Third People's Hospital of Yangxin County;Department of Anesthesiology,Tongji Hospital,Huazhong University of Science and Technology;

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;Department of Anesthesiology,People's Hospital of Yangxin County;Department of Anesthesiology,The Third People's Hospital of Yangxin County;Department of Anesthesiology,Tongji Hospital,Huazhong University of Science and Technology;

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DOI: 10.19367/j.cnki.1000-2707.2018.12.021

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