瑞芬太尼复合麻醉对开腹结肠癌患者细胞因子、T淋巴细胞亚群及氧化应激的影响
|
摘要
目的研究瑞芬太尼复合麻醉对开腹结肠癌患者细胞因子、T淋巴细胞亚群、氧化应激的影响。方法收集德阳市第二人民医院2013年8月至2017年9月收治的择期行开腹结肠癌手术治疗的患者120例,按随机数表法分为观察组和对照组,每组60例。对照组给予舒芬太尼0.1～0.15μg/(kg·h)间断注入~+丙泊酚2～5 mg/(kg·h)静脉泵注,七氟烷吸入行复合麻醉,观察组则给予瑞芬太尼0.10～0.30μg/(kg·min)~+丙泊酚2～5 mg/(kg·h)静脉泵注,七氟烷吸入行复合麻醉,分别记录麻醉前(T0)、插管后3 min (T1)、手术切皮后(T2)、手术进行时(T3)、关腹前(T4)和气管拔管后(T5)各时段的BIS值变化情况,观察两组患者术后恢复情况和不良反应发生情况,分别于术前及术后记录并比较两组患者的血清细胞因子水平[白细胞介素-4 (IL-4)、白细胞介素-8 (IL-8)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)]、T淋巴细胞亚群[CD3~+、CD4~+和CD4~+/CD8~+]、氧化应激水平[超氧化物歧化酶(SOD)、丙二醛(MDA)、过氧化氢酶(CAT)和谷胱甘肽(GSH)]。结果相较于T0,两组患者T1～T4各时间点BIS值均明显下降,而至T5,两组BIS值均明显增高,差异均有统计学意义(P<0.05),但两组患者各时间点的BIS值间比较差异均无统计学意义(P>0.05);两组患者苏醒情况良好,均无呼吸功能障碍及苏醒延迟者;观察组患者术后自主呼吸恢复时间、苏醒时间、导管拔除时间和定向力恢复时间分别为(7.12±1.23) min、(8.10±1.06) min、(14.86±2.38) min、(21.65±3.12) min,均明显短于对照组的(13.65±1.82) min、(14.04±2.15) min、(21.54±3.17) min和(29.89±4.08) min,差异均有统计学意义(P<0.05);术后,观察组患者的血清IL-4、IL-8、CRP和TNF-α水平分别为(20.58±3.67) pg/mL、(52.14±6.72) pg/mL、(12.20±1.56) mg/L、(37.64±5.02) pg/m L,均明显低于对照组的(24.50±3.82) pg/m L、(73.92±2.61) pg/m L、(22.48±3.04) mg/L、(50.60±7.08) pg/mL,差异均具有统计学意义(P<0.05);术后,观察组患者的CD3~+、CD4~+和CD4~+/CD8~+水平分别为(47.61±6.37)%、(26.48±3.71)%、1.18±0.16,均明显高于对照组的(40.23±5.20)%、(22.65±3.02)%、0.93±0.14,CD8~+水平为(22.96±3.31)%,明显低于对照组的(24.32±3.37)%,差异均具有统计学意义(P<0.05);术后,观察组患者的MDA水平为(5.65±0.71) mmol/L,明显低于对照组的(7.85±1.10) mmol/L,SOD、GSH和CAT水平分别为(83.61±7.12) nU/mL、(72.31±9.61) mg/mL和(90.61±10.23) U/mL,均明显高于对照组的(76.84±6.83) nU/mL、(62.35±7.51) mg/mL、(82.65±9.54) U/mL,差异均具有统计学意义(P<0.05);观察组患者术后出现恶心呕吐、寒战、躁动、高血压和呛咳的总不良反应发生率为10.0%,明显低于对照组的30.0%,差异具有统计学意义(P<0.05)。结论将瑞芬太尼复合麻醉应用于开腹结肠癌手术中可有效减轻患者的炎症反应及氧化应激反应,减少对细胞免疫功能的影响,术后苏醒快,不良反应少,安全性高,具有较高的推广价值。
Objective To study the effects of remifentanil combined with anesthesia on cytokines, T lymphocyte subsets, and oxidative stress in patients with colon cancer undergoing open surgery. Methods A total of 120 patients with colon cancer scheduled for open surgery treated in the Second People's Hospital of Deyang City from August2013 to September 2017 were collected. The patients were divided into observation group and control group according to the random number table, with 60 cases in each group. The control group was given intermittent injection of sufentanil0.1-0.15 μg/(kg· h), intravenous pumping of propofol 2-5 mg/(kg· h), and sevoflurane inhalation for anesthesia. The observation group was given remifentanil 0.10-0.30 μg/(kg· min), propofol 2-5 mg/(kg· h), and sevoflurane inhalation for anesthesia. Changes in bispectral index(BIS) values before anesthesia(T0), 3 min after intubation(T1), after surgical incision(T2), during surgery(T3), before abdomen(T4), and after tracheal extubation(T5) were recorded. The postoperative recovery and adverse reactions of the two groups were observed. Serum cytokines(interleukin-4 [IL-4], interleukin-8 [IL-8], C-reactive protein [CRP], and tumor necrosis factor alpha [TNF-α]), T lymphocyte subsets(CD3~+, CD4~+, and CD4~+/CD8~+), oxidative stress(superoxide dismutase [SOD], malondialdehyde [MDA], catalase [CAT], and glutathione[GSH]) were recorded and compared between the two groups before and after surgery. Results Compared with T0, the BIS values of the two groups decreased significantly at time points from T1 to T4, and increased significantly at T5(P<0.05), but there was no significant difference between the two groups at each time point(P>0.05). The recovery of the two groups was good, and there were no respiratory dysfunction and delayed recovery. The recovery time of spontaneous respiration, recovery time, catheter removal time, and orientation recovery time of the observation group were(7.12 ±1.23) min,(8.10±1.06) min,(14.86±2.38) min,(21.65±3.12) min, significantly shorter than(13.65±1.82) min,(14.04±2.15) min,(21.54±3.17) min, and(29.89±4.08) min in the control group(P<0.05). After operation, the serum levels of IL-4, IL-8, CRP, and TNF-α in the observation group were(20.58±3.67) pg/mL,(52.14±6.72) pg/mL,(12.20±1.56) mg/L,(37.64±5.02) pg/mL, which were significantly lower than(24.50±3.82) pg/mL,(73.92±2.61) pg/mL,(22.48±3.04)mg/L,(50.60±7.08) pg/mL of the control group(P<0.05). After operation, the CD3~+, CD4~+, and CD4~+/CD8~+levels in the observation group were(47.61±6.37)%,(26.48±3.71)%, and 1.18±0.16, respectively, which were significantly higher than(40.23±5.20)%,(22.65±3.02)%, 0.93±0.14 of the control group(P<0.05), and the CD8~+level in the observation group was(22.96±3.31)%, which was significantly lower than(24.32±3.37)% of the control group(P<0.05). After operation, the MDA level of the observation group was(5.65±0.71) mmol/L, which was significantly lower than(7.85±1.10)mmol/L of the control group, and the SOD, GSH, and CAT levels were(83.61±7.12) nU/mL,(72.31±9.61) mg/mL,and(90.61±10.23) U/mL, significantly higher than(76.84±6.83) nU/mL,(62.35±7.51) mg/mL,(82.65±9.54) U/mL of the control group(P<0.05). The incidence of total adverse reactions such as nausea and vomiting, chills, agitation, hypertension and cough in the observation group was 10.00%, which was significantly lower than 30.00% of the control group(P<0.05). Conclusion Remifentanil combined with anesthesia can effectively reduce the inflammatory response and oxidative stress response in patients with colon cancer undergoing open surgery, reduce the impact on cellular immune function, results in quick recovery after surgery, less adverse reactions, and high safety, which thus has a high promotion value.
Objective To study the effects of remifentanil combined with anesthesia on cytokines, T lymphocyte subsets, and oxidative stress in patients with colon cancer undergoing open surgery. Methods A total of 120 patients with colon cancer scheduled for open surgery treated in the Second People's Hospital of Deyang City from August2013 to September 2017 were collected. The patients were divided into observation group and control group according to the random number table, with 60 cases in each group. The control group was given intermittent injection of sufentanil0.1-0.15 μg/(kg· h), intravenous pumping of propofol 2-5 mg/(kg· h), and sevoflurane inhalation for anesthesia. The observation group was given remifentanil 0.10-0.30 μg/(kg· min), propofol 2-5 mg/(kg· h), and sevoflurane inhalation for anesthesia. Changes in bispectral index(BIS) values before anesthesia(T0), 3 min after intubation(T1), after surgical incision(T2), during surgery(T3), before abdomen(T4), and after tracheal extubation(T5) were recorded. The postoperative recovery and adverse reactions of the two groups were observed. Serum cytokines(interleukin-4 [IL-4], interleukin-8 [IL-8], C-reactive protein [CRP], and tumor necrosis factor alpha [TNF-α]), T lymphocyte subsets(CD3~+, CD4~+, and CD4~+/CD8~+), oxidative stress(superoxide dismutase [SOD], malondialdehyde [MDA], catalase [CAT], and glutathione[GSH]) were recorded and compared between the two groups before and after surgery. Results Compared with T0, the BIS values of the two groups decreased significantly at time points from T1 to T4, and increased significantly at T5(P<0.05), but there was no significant difference between the two groups at each time point(P>0.05). The recovery of the two groups was good, and there were no respiratory dysfunction and delayed recovery. The recovery time of spontaneous respiration, recovery time, catheter removal time, and orientation recovery time of the observation group were(7.12 ±1.23) min,(8.10±1.06) min,(14.86±2.38) min,(21.65±3.12) min, significantly shorter than(13.65±1.82) min,(14.04±2.15) min,(21.54±3.17) min, and(29.89±4.08) min in the control group(P<0.05). After operation, the serum levels of IL-4, IL-8, CRP, and TNF-α in the observation group were(20.58±3.67) pg/mL,(52.14±6.72) pg/mL,(12.20±1.56) mg/L,(37.64±5.02) pg/mL, which were significantly lower than(24.50±3.82) pg/mL,(73.92±2.61) pg/mL,(22.48±3.04)mg/L,(50.60±7.08) pg/mL of the control group(P<0.05). After operation, the CD3~+, CD4~+, and CD4~+/CD8~+levels in the observation group were(47.61±6.37)%,(26.48±3.71)%, and 1.18±0.16, respectively, which were significantly higher than(40.23±5.20)%,(22.65±3.02)%, 0.93±0.14 of the control group(P<0.05), and the CD8~+level in the observation group was(22.96±3.31)%, which was significantly lower than(24.32±3.37)% of the control group(P<0.05). After operation, the MDA level of the observation group was(5.65±0.71) mmol/L, which was significantly lower than(7.85±1.10)mmol/L of the control group, and the SOD, GSH, and CAT levels were(83.61±7.12) nU/mL,(72.31±9.61) mg/mL,and(90.61±10.23) U/mL, significantly higher than(76.84±6.83) nU/mL,(62.35±7.51) mg/mL,(82.65±9.54) U/mL of the control group(P<0.05). The incidence of total adverse reactions such as nausea and vomiting, chills, agitation, hypertension and cough in the observation group was 10.00%, which was significantly lower than 30.00% of the control group(P<0.05). Conclusion Remifentanil combined with anesthesia can effectively reduce the inflammatory response and oxidative stress response in patients with colon cancer undergoing open surgery, reduce the impact on cellular immune function, results in quick recovery after surgery, less adverse reactions, and high safety, which thus has a high promotion value.
引文
[1]郝建礼,黄泽清.右旋美托咪定复合瑞芬太尼用于老年高血压患者腹腔镜结肠癌根治术的临床观察[J].实用药物与临床,2014,17(3):298-301.
[2]黄凯清,陈祯,邓琅辉,等.Narcotrend监测下不同麻醉诱导方法对高龄结肠癌手术患者血压与心率的影响[J].广东医学,2013,34(3):432-435.
[3]NOMURA Y,KAWARAGUCHI Y,SUGIMOTO H,et al.Effects of morphine and fentanyl on 5-fluorouracil sensitivity in human colon cancer HCT116 cells[J].J Anesth,2014,28(2):298-301.
[4]赵莉,王志红,李学斌,等.瑞芬太尼对人结肠癌COLO205细胞增殖及凋亡的影响[J].国际麻醉学与复苏杂志,2017,38(5):401-403.
[5]中华人民共和国国家卫生和计划生育委员会.结肠癌规范化诊疗指南(试行)[J].中国医学前沿杂志(电子版),2013,5(8):47-51.
[6]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[7]熊章荣,蒋燕,邓永乐,等.靶控输注瑞芬太尼复合七氟醚吸入麻醉用于老年肿瘤患者的临床评价[J].重庆医学,2011,40(3):266-268.
[8]CHRISTOPHERSON R,JAMES KE,TABLEMAN M,et al.Long-term survival after colon cancer surgery:a variation associated with choice of anesthesia[J].Anesth Analg,2008,107(1):325-332.
[9]崔明珠,张加强,孟凡民,等.右美托咪定复合丙泊酚-瑞芬太尼用于轻度肝功能异常患者开腹术麻醉的适宜剂量[J].中华麻醉学杂志,2013,33(8):959-962.
[10]屈惠,杨怡,吉恩秀,等.右美托咪定联合瑞芬太尼对结肠癌患者术后认知功能及血流动力学的影响[J].中国药房,2017,28(8):1101-1104.
[11]王云川,陈有英,王军,等.硬膜外阻滞对老年全身麻醉下腹腔镜结肠癌根治术后认知功能的影响[J].重庆医学,2015,44(18):2499-2500.
[12]尉明洋,周燕丰,金海燕,等.瑞芬太尼复合七氟烷靶控输注在老年肿瘤患者临床麻醉中的价值[J].中国老年学杂志,2014,34(19):5475-5477.
[13]邓敏,冯增光.靶控输注舒芬太尼和瑞芬太尼复合麻醉在腹腔镜下结直肠癌根治术患者的恢复情况比较[J].医学综述,2015,21(14):2670-2672.
[14]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[15]CHEN WK,REN L,WEI Y,et al.General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.
[16]华庆丽,孙丽,宋兵,等.瑞芬太尼复合麻醉对开腹结肠癌手术术后患者白细胞介素-8及氧化应激的影响[J].中国老年学杂志,2017,37(13):3232-3235.
[17]杨华,郝雪莲,何文龙,等.全麻联合硬膜外阻滞对老年腹腔镜结肠癌根治术后认知功能障碍的影响[J].中国普通外科杂志,2016,25(10):1512-1516.
[18]王言武.2种不同麻醉方法对腹腔镜结肠癌患者围术期细胞免疫及IL-6的影响[J].实用癌症杂志,2015,30(3):355-358.
[19]徐凤莲,邓芳,龙裔宁,等.七氟醚与丙泊酚麻醉对结肠癌根治术中老年患者血液流变学指标的影响[J].中国生化药物杂志,2017,37(3):240-242.
[20]李敏捷,黄靖豪,林健清,等.瑞芬太尼对老年结肠癌根治术患者细胞角蛋白20 mRNA、γ-干扰素、白细胞介素-10及T淋巴亚群水平的影响[J].中国老年学杂志,2016,36(19):4845-4844.
[2]黄凯清,陈祯,邓琅辉,等.Narcotrend监测下不同麻醉诱导方法对高龄结肠癌手术患者血压与心率的影响[J].广东医学,2013,34(3):432-435.
[3]NOMURA Y,KAWARAGUCHI Y,SUGIMOTO H,et al.Effects of morphine and fentanyl on 5-fluorouracil sensitivity in human colon cancer HCT116 cells[J].J Anesth,2014,28(2):298-301.
[4]赵莉,王志红,李学斌,等.瑞芬太尼对人结肠癌COLO205细胞增殖及凋亡的影响[J].国际麻醉学与复苏杂志,2017,38(5):401-403.
[5]中华人民共和国国家卫生和计划生育委员会.结肠癌规范化诊疗指南(试行)[J].中国医学前沿杂志(电子版),2013,5(8):47-51.
[6]洪彬源,陈桂纯,王云花,等.多模式麻醉药物合用对结肠癌根治术患者免疫功能的影响[J].广东医学,2016,37(20):3080-3083.
[7]熊章荣,蒋燕,邓永乐,等.靶控输注瑞芬太尼复合七氟醚吸入麻醉用于老年肿瘤患者的临床评价[J].重庆医学,2011,40(3):266-268.
[8]CHRISTOPHERSON R,JAMES KE,TABLEMAN M,et al.Long-term survival after colon cancer surgery:a variation associated with choice of anesthesia[J].Anesth Analg,2008,107(1):325-332.
[9]崔明珠,张加强,孟凡民,等.右美托咪定复合丙泊酚-瑞芬太尼用于轻度肝功能异常患者开腹术麻醉的适宜剂量[J].中华麻醉学杂志,2013,33(8):959-962.
[10]屈惠,杨怡,吉恩秀,等.右美托咪定联合瑞芬太尼对结肠癌患者术后认知功能及血流动力学的影响[J].中国药房,2017,28(8):1101-1104.
[11]王云川,陈有英,王军,等.硬膜外阻滞对老年全身麻醉下腹腔镜结肠癌根治术后认知功能的影响[J].重庆医学,2015,44(18):2499-2500.
[12]尉明洋,周燕丰,金海燕,等.瑞芬太尼复合七氟烷靶控输注在老年肿瘤患者临床麻醉中的价值[J].中国老年学杂志,2014,34(19):5475-5477.
[13]邓敏,冯增光.靶控输注舒芬太尼和瑞芬太尼复合麻醉在腹腔镜下结直肠癌根治术患者的恢复情况比较[J].医学综述,2015,21(14):2670-2672.
[14]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[15]CHEN WK,REN L,WEI Y,et al.General anesthesia combined with epidural anesthesia ameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.
[16]华庆丽,孙丽,宋兵,等.瑞芬太尼复合麻醉对开腹结肠癌手术术后患者白细胞介素-8及氧化应激的影响[J].中国老年学杂志,2017,37(13):3232-3235.
[17]杨华,郝雪莲,何文龙,等.全麻联合硬膜外阻滞对老年腹腔镜结肠癌根治术后认知功能障碍的影响[J].中国普通外科杂志,2016,25(10):1512-1516.
[18]王言武.2种不同麻醉方法对腹腔镜结肠癌患者围术期细胞免疫及IL-6的影响[J].实用癌症杂志,2015,30(3):355-358.
[19]徐凤莲,邓芳,龙裔宁,等.七氟醚与丙泊酚麻醉对结肠癌根治术中老年患者血液流变学指标的影响[J].中国生化药物杂志,2017,37(3):240-242.
[20]李敏捷,黄靖豪,林健清,等.瑞芬太尼对老年结肠癌根治术患者细胞角蛋白20 mRNA、γ-干扰素、白细胞介素-10及T淋巴亚群水平的影响[J].中国老年学杂志,2016,36(19):4845-4844.