原发性肝癌肝切除术中不同浓度七氟烷结合丙泊酚方案的麻醉效果及病人免疫功能观察

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doi:10.3969/j.issn.1005-6483.20240550

摘要： 目的探讨原发性肝癌肝切除术中不同浓度七氟烷结合丙泊酚方案的麻醉效果及病人免疫功能变化情况。方法采用单盲法，前瞻性选取2023年1月~2023年9月收治的原发性肝癌病人120例，采用随机数字表法将病人纳入对照组(60例)和观察组(60例)。在行肝癌切除术时，对照组给予0.5肺泡最小有效浓度(MAC)七氟烷结合丙泊酚靶控输注麻醉，观察组给予1.0MAC七氟烷结合丙泊酚靶控输注麻醉，两组术后均观察3天。比较两组围手术期相关指标，拔管即刻、拔管后15分钟、拔管后30分钟的镇静情况、苏醒质量，术前、术后1、3天的认知功能，麻醉诱导前、麻醉诱导后、插管即刻、术毕时的生命体征，术前、术后1天的免疫功能及观察期间的不良反应。结果观察组拔管、自主呼吸恢复、定向力恢复、苏醒时间分别为(11.25±1.69)分钟、(9.76±1.34)分钟、(69.23±3.35)分钟、(10.13±1.43)分钟，对照组分别为(14.57±2.28)分钟、(13.55±2.76)分钟、(73.44±4.52)分钟、(14.26±2.25)分钟，观察组均短于对照组，两组比较差异有统计学意义(P<0.05)。观察组拔管即刻的Ramsay镇静评分为(4.16±0.22)分，对照组为(3.21±0.10)分；观察组拔管即刻、拔管后15分钟的苏醒室标准(Aldrete)评分分别为(9.56±0.12)分、(9.77±0.20)分，对照组分别为(9.02±0.13)分、(9.05±0.17)分；观察组术后1 天的简易精神状态量表(MMSE)评分为(26.23±1.12)分，对照组为(25.17±0.98)分，观察组均高于对照组，两组比较差异有统计学意义(P<0.05)。观察组插管即刻、术毕时的心率(HR)分别为(73.08±4.10)次/分钟、(75.27±6.03)次/分钟，平均动脉压(MAP)分别为(81.56±4.49)mmHg、(86.07±5.48)mmHg，对照组HR分别为(75.47±5.78)次/min、(77.91±6.79)次/min，MAP分别为(85.2±5.08)mmHg、(88.25±6.01)mmHg，观察组均低于对照组，两组比较差异有统计学意义(P<0.05)。观察组术后1天的全血自然杀伤细胞(NK)、CD4+、CD4+/CD8+分别为(35.62±5.54)%、(50.09±3.32)%、(1.42±0.25)，对照组分别为(24.12±4.09)%、(43.17±4.20)%、(1.20±0.19)，观察组均高于对照组，差异有统计学意义(P<0.05)；观察组全血CD8+为(26.55±3.02)%，对照组为(28.71±4.45)%，观察组低于对照组，差异有统计学意义(P<0.05)。观察组观察期间的不良反应总发生率为16.67%，对照组为5.00%，观察组高于对照组，差异有统计学意义(P<0.05)。结论与0.5MAC七氟烷结合丙泊酚靶控输注麻醉相比，1.0 MAC七氟烷结合丙泊酚靶控输注麻醉对原发性肝癌肝切除术病人的血流动力学及免疫功能影响较小，并可提高病人苏醒质量，改善认知功能，促进术后恢复，麻醉效果较好，但其不良反应较多。

关键词: 原发性肝癌, 肝切除术, 七氟烷, 丙泊酚, 免疫功能

Abstract: Objective To investigate the anesthesia effects of different concentrations of sevoflurane combined with propofol during primary liver cancer resection surgery,as well as the changes in immune function in patients.Methods Using single-blind method,120 cases of primary hepatocellular carcinoma admitted to the Third Affiliated Hospital of Naval Military Medical University from January 2023 to September 2023 were prospectively selected as the study subjects,and the patients were randomly (using the randomized numerical table method) included in the control group (60 cases) and the observation group (60 cases).During hepatic cancer resection,the control group was given 0.5 alveolar minimum effective concentration (MAC) sevoflurane combined with propofol target-controlled infusion anesthesia,and the observation group was given 1.0 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,and both groups were observed for 3 d postoperatively.The perioperative related indexes,the sedation and quality of awakening in the immediate moment of extubation,15 min after extubation,and 30 min after extubation,the cognitive function before and at 1 and 3 d postoperatively,vital signs before induction of anesthesia,after induction of anesthesia,at the moment of intubation,at the end of surgery,immune function before and 1 d postoperative,and adverse reactions during the observation period were compared between the two groups.Results The time for extubation,recovery of spontaneous respiration,recovery of orientation,and awakening in the observation group were (11.25±1.69) min,(9.76±1.34) min,(69.23±3.35) min,and (10.13±1.43) min,and the control group were (14.57±2.28) min,(13.55±2.76) min,(73.44±4.52) min,(14.26±2.25) min,all of which were shorter in the observation group than in the control group (P<0.05).The Ramsay sedation score at the immediate moment of extubation was (4.16±0.22) in the observation group,and (3.21±0.10) in the control group; the standardized (Aldrete) score in the awakening room of the observation group at the immediate moment of extubation,and 15 min after extubation were (9.56±0.12) and (9.77±0.20),respectively,and the control group was (9.02±0.13),respectively,(9.05±0.17) points; the scores of the brief mental state examination (MMSE) scale in the observation group were (26.23±1.12) points and (25.17±0.98) points in the control group in the 1 d postoperative period,which were higher than those of the control group (P<0.05).The heart rate (HR) at the moment of intubation and at the end of operation in the observation group were (73.08±4.10) beats/min,(75.27±6.03) beats/min,and the mean arterial pressure (MAP) was (81.56±4.49) mmHg and (86.07±5.48) mmHg,respectively,and in the control group the HR was (75.47±5.78) beats/min,(77.91±6.79) beats/min,and the MAP was (85.22±5.08) mmHg and (88.25±6.01) mmHg in the observation group,respectively,which were lower than those in the control group (P<0.05).The whole blood natural killer (NK) cells,CD4+ and CD4+/CD8+ in the observation group at 1 d postoperatively were (35.62±5.54)%,(50.09±3.32)%,and (1.42±0.25),the control group were (24.12±4.09)%,(43.17±4.20)%,and (1.20±0.19),the observation group was higher than the control group (P<0.05); whole blood CD8+ was (26.55±3.02)% in the observation group and (28.71±4.45)% in the control group,the observation group was lower than the control group (P<0.05).The total incidence of adverse reactions during the observation period was 16.67% in the observation group and 5.00% in the control group,which was higher than the control group (P<0.05).Conclusion Compared with 0.5 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,1.0 MAC sevoflurane combined with propofol targetcontrolled infusion anesthesia had less effect on hemodynamics and immune function in patients undergoing resection for primary hepatocellular carcinoma,and it could improve the quality of patients’ awakening,cognitive function,and promote postoperative recovery,and the anesthesia was more effective,but it had more adverse effects.

Key words: primary liver cancer, hepatic resection, sevoflurane, propofol, immunologic function

许婧乔雪孙玉明王博. 原发性肝癌肝切除术中不同浓度七氟烷结合丙泊酚方案的麻醉效果及病人免疫功能观察[J]. 临床外科杂志, 2025, 33(2): 191-195.

XU Jing, QIAO Xue, SUN Yuming, WANG Bo. Anesthesia effect of different concentration of sevoflurane combined with propofol regimen and patient’s immune function observation during hepatic resection for primary hepatocellular carcinoma[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(2): 191-195.

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