丙泊酚静脉麻醉与七氟烷吸入麻醉对胃癌患者术中及术后效果的比较

Comparison of intraoperative and postoperative effects of intravenous propofol anesthesia and sevoflurane inhalation anesthesia in patients undergoing laparoscopic radical gastrectomy for gastric cancer

摘要:

目的 分析丙泊酚静脉麻醉与七氟烷吸入麻醉对胃癌患者术中及术后效果的影响。方法 选取2023年1月—2024年10月空军军医大学西京医院第九八六医院98例接受腹腔镜胃癌根治术的患者为研究对象，采用随机数字表法分为静脉组与吸入组，各49例。静脉组患者接受丙泊酚泵注下全凭静脉麻醉，吸入组患者接受七氟烷吸入麻醉。比较两组麻醉效果［心率（HR）、呼吸频率（PR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO₂）］、术后1、3、5 h的视觉模拟评分法（VAS）评分、免疫指标［CD3⁺T淋巴细胞（CD3⁺）、CD4⁺T淋巴细胞（CD4⁺）、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）］及不良反应的差异。结果 静脉组HR、MAP和SpO₂均高于吸入组，PR低于吸入组（P <0.05）。静脉组与吸入组术后1、3、5 h的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②静脉组与吸入组VAS评分比较，差异有统计学意义（P <0.05），静脉组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。静脉组术后24 h的CD3⁺、CD4⁺、IgM和IgA均高于对照组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 丙泊酚静脉麻醉相比七氟烷吸入麻醉在胃癌患者术中具有更好的生理稳定性，术后疼痛控制更优，且能更好地维持免疫功能，两者麻醉相关不良反应发生情况相似。

Abstract:

Objective To compare the effects of intravenous propofol anesthesia and sevoflurane inhalation anesthesia on intraoperative and postoperative outcomes in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Methods A total of 98 patients who underwent laparoscopic radical gastrectomy for gastric cancer at The 986th Hospital (Xijing Hospital), Air Force Medical University from January 2023 to October 2024 were selected as study subjects. Using a random number table method, they were divided into an intravenous group and an inhalation group, with 49 patients in each group. The intravenous group received total intravenous anesthesia with propofol infusion, while the inhalation group received sevoflurane inhalation anesthesia. The two groups were compared in terms of anesthetic effects [heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), pulse oxygen saturation (SpO₂) ], Visual Analogue Scale (VAS) scores at 1, 3, and 5 hours postoperatively, immune indices [CD3⁺ T lymphocytes (CD3⁺), CD4⁺ T lymphocytes (CD4?), immunoglobulin M (IgM), immunoglobulin A (IgA) ], and the incidence of adverse reactions.Results The HR, MAP, and SpO? in the intravenous group were higher than those in the inhalation group, and the RR was lower than that in the inhalation group (P < 0.05). The comparison of VAS scores at 1, 3, and 5 hours postoperatively between the intravenous group and the inhalation group showed that: (1) the VAS scores at different time points were significantly different (P < 0.05); (2) the VAS scores of the intravenous group were significantly lower than those of the inhalation group (P < 0.05), indicating better analgesic effect in the intravenous group; (3) the change trends of VAS scores between the two groups were significantly different (P < 0.05). The levels of CD3⁺, CD4⁺, IgM, and IgA at 24 hours postoperatively in the intravenous group were higher than those in the inhalation group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion Compared with sevoflurane inhalation anesthesia, intravenous propofol anesthesia provides better intraoperative physiological stability, superior postoperative pain control, and better preservation of immune function in patients with gastric cancer, with a similar incidence of anesthesia-related adverse reactions.