食管癌根治术患者应用麻醉药物对其炎症反应及肺功能的影响

发布时间：2019-06-12 11:48

【摘要】：目的研究单肺通气下行食管癌根治术中使用丙泊酚、七氟烷麻醉药物对患者炎症反应及肺功能的影响,以降低感染率。方法选择2011年4月-2013年4月在医院接受食管癌根治手术的患者92例作为研究对象,根据数字法将患者随机分成丙泊酚组与七氟烷组,各46例,对比两组患者在不同时间点的肺泡-动脉氧分压差(PA-aO2)、氧合指数(OI)及呼吸指数(RI)水平,两组患者在不同时间点的血浆白细胞介素-1(IL-1)及核转录因子KB(NF-kB)DNA结合活性水平以及围手术期感染发生率。结果与气管插管之后5min相比,七氟烷组患者通气后30、60、90min的PA-aO2水平均增加,两组患者通气后30min至双肺通气时的OI水平均下降;与七氟烷组相比,丙泊酚组通气后60min至手术结束时的RI水平均降低,差异均有统计学意义(P0.05);七氟烷组手术结束时的血浆IL-1水平上升,丙泊酚组通气后30、60min、恢复至双肺通气后10min及手术结束时的血浆IL-1水平显著降低;与七氟烷组相比,丙泊酚组单肺通气开始时及手术结束时的NF-kB DNA结合活性水平显著下降,差异均有统计学意义(P0.05);两组患者围手术期的感染率对比,差异无统计学意义。结论单肺通气下实施食管癌根治手术时应用丙泊酚麻醉,对患者的炎性反应以及肺功能的影响更小,感染率亦较低,值得推广应用。
[Abstract]:Objective To study the effects of propofol and sevoflurane on the inflammatory response and lung function of patients with single-lung ventilation in the radical operation of esophageal cancer, to reduce the infection rate. Methods 92 patients who underwent radical operation in the hospital from April 2011 to April 2013 were randomly divided into propofol group and sevoflurane group according to the digital method,46 cases were divided into propofol group and sevoflurane group, and the partial pressure difference (PA-aO2) between the two groups at different time points was compared. The levels of oxygenation index (OI) and respiratory index (RI), plasma interleukin-1 (IL-1) and nuclear transcription factor KB (NF-kB) DNA binding activity in two groups at different time points and the incidence of perioperative infection. Results The levels of PA-aO2 at 30,60 and 90 min were increased in the group of sevoflurane compared with the 5 min after the tracheal intubation, and the level of OI decreased from 30 min to the double-lung ventilation in the two groups. Compared with the sevoflurane group, the RI level at the end of 60 min after ventilation of the propofol group and the end of the operation decreased, There was a significant difference in plasma IL-1 level at the end of operation of the sevoflurane group, the level of plasma IL-1 in the group of propofol group was 30 and 60 min, and the level of plasma IL-1 at the end of operation was significantly lower than that at the end of the operation; compared with the sevoflurane group, There was a significant difference in the level of NF-kB DNA binding activity at the beginning of single-lung ventilation and at the end of the operation (P0.05). Conclusion The application of propofol on the treatment of esophageal cancer under single-lung ventilation is less effective in the treatment of the inflammatory reaction and the function of the lung, and the infection rate is lower.
【作者单位】：嘉兴市第一医院麻醉与疼痛医学中心;
【基金】：嘉兴市科技基金资助项目(2011AY1050-1)
【分类号】：R614;R735.1

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