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

摘要：

目的　观察丙泊酚泵注下的全凭静脉麻醉与吸入麻醉用于胃癌根治术全麻的麻醉效果及对患者免疫功能的影响。方法　本文为随机对照试验，病例纳入2021年1月至2022年1月至南阳医学高等专科学校第一附属医院接受胃癌根治术治疗的136例胃癌患者为研究对象，采用抽签法将患者均分为两组，每组68例。将采用丙泊酚泵注下全凭静脉麻醉的患者列为静脉组［男/女=35/33，年龄（55.24±5.17）岁］，将采用七氟烷吸入麻醉的患者列为吸入组［男/女=38/30，年龄（55.33±5.25）岁］。比较两组患者术中、术后镇痛效果，免疫功能及麻醉相关不良反应发生情况。采用χ²检验、t检验。结果　在不同麻醉方案下，静脉组术中心率（HR）（65.45±5.28）次/min高于吸入组（62.33±5.17）次/min（t=3.482，P<0.001），平均动脉压（MAP）（90.44±10.27）mmHg（1 mmHg=0.133 kPa）高于吸入组（85.33±10.16） mmHg（t=2.917，P=0.004），血氧饱和度（SaO₂）（98.24±5.11）%高于吸入组（95.12±5.36）%（t=3.474，P<0.001），呼吸频率（PR）（20.26±2.35）次/min低于吸入组（21.37±2.46）次/min（t=2.691，P=0.008）。静脉组术后1、3、5 h的视觉模拟疼痛量表（VAS）评分均低于吸入组（均P<0.05）。术前，两组患者T淋巴细胞亚群、免疫球蛋白（Ig）等免疫指标差异均无统计学意义（均P>0.05）；术后，两组患者免疫功能均受到一定抑制，但静脉组的CD3+（38.77±5.16）%高于吸入组（36.33±5.25）%（t=2.733，P=0.007），CD4+（45.15±5.24）%高于吸入组（42.27±5.16）%（t=3.229，P=0.002），IgM（1.22±0.35）g/L高于吸入组（0.95±0.64）g/L（t=3.052，P=0.003），IgA（1.52±0.76）g/L高于吸入组（0.96±0.61）g/L（t=4.739，P<0.001）。静脉组的麻醉相关不良反应发生率7.35%（5/68）略高于吸入组5.88%（4/68）（χ²=0.175，P=0.676）。结论　采用丙泊酚泵注下的全凭静脉麻醉辅助胃癌根治术治疗可起到更加显著的术中、术后镇痛效果，且与吸入麻醉相比，全凭静脉麻醉对患者免疫功能产生的抑制作用更轻，且全凭静脉麻醉并未明显增加患者发生麻醉相关不良反应的风险。

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