关键词:

胃癌根治术, 丙泊酚泵注, 全凭静脉麻醉, 吸入麻醉, 免疫功能

Abstract:

Objective　To observe the effects of total intravenous anesthesia with propofol pump and inhalation anesthesia on general anesthesia and immune function in patients undergoing radical gastrectomy. Methods　This was a randomized controlled trial. A total of 136 patients with gastric cancer who received radical surgery for gastric cancer in The First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2022 were included in the study. The patients were divided into two groups by lotting, with 68 patients in each group. The patients who received total intravenous anesthesia with propofol pump were classified as the intravenous group [the ratio of men to women was 35/33, with an age of (55.24±5.17) years old], and the patients who received sevoflurane inhalation anesthesia were classified as the inhalation group [the ratio of men to women was 38/30, with an age of (55.33±5.25) years old]. The analgesic effects during and after surgery, immune function, and occurrence of anesthesia related adverse reactions were compared between the two groups. χ² test and t test were used. Results　Under different anesthesia schemes, the intraoperative heart rate (HR) in the intravenous group was higher than that in the inhalation group [(65.45±5.28) beats/min vs. (62.33±5.17) beats/min] (t=3.482, P<0.001), the mean arterial pressure (MAP) was higher than that in the inhalation group [(90.44±10.27) mmHg (1 mmHg = 0.133 kPa) vs. (85.33±10.16) mmHg] (t=2.917, P=0.004), the blood oxygen saturation was higher than that in the inhalation group [(98.24±5.11)% vs. (95.12±5.36)%] (t=3.474, P<0.001), and the respiratory rate (PR) was lower than that in the inhalation group [(20.26±2.35) times/min vs. (21.37±2.46) times/min] (t=2.691, P=0.008). The Visual Analogue Scale (VAS) scores of the intravenous group 1, 3, and 5 h after surgery were lower than those of the inhalation group (all P<0.05). Before surgery, there were no statistically significant differences in the T lymphocyte subsets, immunoglobulin (Ig), and other immune indexes between the two groups (all P>0.05). After surgery, the immune function of both groups was inhibited to some extent, but the CD3+ in the intravenous group was higher than that in the inhalation group [(38.77±5.16)% vs. (36.33±5.25)%] (t=2.733, P=0.007), the CD4+ was higher than that in the inhalation group [(45.15±5.24)% vs. (42.27±5.16)%] (t=3.229, P=0.002), the IgM was higher than that in the inhalation group [(1.22±0.35) g/L vs. (0.95±0.64) g/L] (t=3.052, P=0.003), and the IgA was higher than that in the inhalation group [(1.52±0.76) g/L vs. (0.96±0.61) g/L] (t=4.739, P<0.001). The incidence of anesthesia-related adverse reactions in the intravenous group was slightly higher than that in the inhalation group [7.35% (5/68) vs. 5.88% (4/68)] (χ²=0.175, P=0.676). Conclusions　Total intravenous anesthesia with propofol pump assisted radical gastrectomy can play more significant analgesic effect during and after surgery. Compared with inhalation anesthesia, total intravenous anesthesia has less inhibitory effect on patients' immune function, and does not significantly increase the risk of anesthesia related adverse effects in patients.

Key words:

Radical gastrectomy, Propofol pump, Total intravenous anesthesia, Inhalation anesthesia, Immune function