目的 比较七氟烷两种不同诱导方式对老年肿瘤患者血流动力学和免疫功能的影响.方法 选取全身麻醉下行择期手术的老年肿瘤患者160例,按麻醉方法分为观察组和对照组,每组80例.观察组患者采用七氟烷初始浓度为2%,每间隔3次呼吸使七氟烷浓度增加1%,至最终浓度为4%~5%的诱导方法;对照组患者采用七氟烷浓度始终为5%的诱导方法.记录两组患者麻醉诱导时间、插管时间、苏醒时间、不良反应;观察心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、脑电双频指数(BIS)及CD3+、CD4+、CD8+、CD4+/CD8+变化情况.结果 两组间BIS、心率、SpO2、CD3+、CD8+和不良反应发生率比较差异无统计学意义(P>0.05);观察组插管即刻MAP明显高于对照组[(69.38±10.42)mmHg比(58.52±6.12)mmHg,1 mmHg=0.133 kPa],而插管后即刻明显低于对照组[(77.12±11.31)mmHg比(90.13±9.24)mmHg],差异有统计学意义(P<0.05).观察组诱导时间和插管时间明显长于对照组[(110.1±14.2)s比(101.4±15.8)s和(341.2±57.3)s比(310.4±60.8)s],而苏醒时间明显短于对照组[(271.2±31.3)s比(321.8±41.5)s],差异有统计学意义(P<0.05).观察组手术结束时和术后1 d CD4+和CD4+/CD8+明显高于对照组(CD4+:0.241±0.027比0.182±0.034和0.332±0.039比0.284±0.042;CD4+/CD8+:0.84±0.12比0.69±0.13和1.09±0.52比0.93±0.43),差异有统计学意义(P<0.05).结论 逐渐增加七氟烷吸入浓度的诱导方法使老年肿瘤患者血流动力学更为平稳,且一定程度上减少了对患者机体T淋巴细胞的抑制作用.
Objective To compare the effect of different sevoflurane induction methods on hemodynamics and immune function in elderly patients with tumor. Methods One hundred and sixty elderly patients with tumor underwent general anesthesia were enrolled, the patients were divided into observation group and control group according to the anesthesia method with 80 cases each. The observation group was received induction method of initial concentration of 2%sevoflurane and increased by 1% per 3 times breathing and then to a final concentration of 4%- 5%. The control group was received 5% sevoflurane induction concentration. The anesthesia induction time, intubation time, recovery time and untoward reaction were recorded. The changes of heart rate, mean arterial pressure (MAP), oxygen saturation of pulse (SpO2), bispectral index (BIS) and CD3+, CD4+, CD8+, CD4+/CD8+were observed. Results There were no statistical differences in BIS, heart rate, SpO2, CD3 +, CD8 + and incidence of untoward reaction between 2 groups (P>0.05). The MAP at immediate intubation in observation group was significantly higher than that in control group:(69.38 ± 10.42) mmHg (1 mmHg=0.133 kPa) vs. (58.52 ± 6.12) mmHg, but the MAP at after intubation was significantly lower than that in control group: (77.12 ± 11.31) mmHg vs. (90.13 ± 9.24) mmHg, there were statistical differences (P<0.05). The anesthesia induction time and intubation time in observation group were significantly longer than those in control group:(110.1 ± 14.2) s vs. (101.4 ± 15.8) s and (341.2 ± 57.3) s vs. (310.4 ± 60.8) s, but the recovery time was significantly shorter than that in control group: (271.2 ± 31.3) s vs. (321.8 ± 41.5) s, there were statistical differences (P<0.05). The CD4+and CD4+/CD8+at end of surgery and 1 d after surgery in observation group were significantly higher than those in control group, CD4+:0.241 ± 0.027 vs. 0.182 ± 0.034 and 0.332 ± 0.039 vs. 0.284 ± 0.042, CD4+/CD8+: 0.84 ± 0.12 vs. 0.69 ± 0.13 and 1.09 ± 0.52 vs. 0.93 ± 0.43, there were statistical differences (P<0.05). Conclusions Induction method of gradually increasing concentration of sevoflurane enables the hemodynamics of elderly tumor patients more stable. In addition, this method can reduce the inhibitory effect on T lymphocytes to some extent.