| Objective:To study the effects of propofol and sevoflurane on perioperative immune inflammatory response and hemodynamics in patients undergoing thoracoscopic surgery.Methods:Forty patients with lung diseases undergoing thoracoscopic surgery under general anesthesia were selected.ASA grade I-III,preoperative cardiac function grade I-II,age50-75 years old,without severe obstructive or restrictive ventilation and / or ventilation disorders,and those who had taken benzodiazepines,immunosuppressive agents,opioids,mental or intellectual disorders in the past two months were excluded.TNM stage of malignant tumor was excluded Patients with stage III / IV,those with difficult double lumen intubation and poor positioning,patients with intraoperative blood transfusion and patients with cephalosporin allergy were excluded.The patients were fasted for 6-8h before operation.Without preoperative drugs,they entered the operating room to open the peripheral venous access and were given routine induction intubation.The observation group was anesthetized with propofol,the control group was anesthetized with sevoflurane inhalation,and the two groups were treated with ultrasound-guided paravertebral nerve block.Both groups maintained the same anesthesia depth.HR,map,SVV and CO were recorded at T0,T1,T2 and T3.The changes of inflammatory factors and immune cells in peripheral blood before anesthesia induction(T0),3 hours(T1),24hours(T2),72 hours(T3)and 7 days(T4)were also compared.Hemodynamics,inflammatory response,immune cells,postoperative recovery and adverse reactions were compared between the two groups.SPSS13.0 software was used to collate the data.The measurement data were represented by mean standard deviation(`x±s).The independent sample t test was used for the comparison between groups.The two factor ANOVA was used for the comparison within groups.Chi square test was used for the comparison of the count data.P < 0.05 was statistically significant.Results:(1)There was no significant change in MAP at T1,T2 and T3 time points compared with T0 in both groups,which was not statistically significant(p>0.05).HR and CO were significantly higher at T1,T2 and T3 than at T0 in both groups,and the difference was statistically significant(p < 0.05).SVV in both groups increased compared with T0 at T1 and T2.There was no significant change in MAP during surgery in both groups,and there was no significant difference in MAP and SVV at the same time,which was not statistically significant(p>0.05).The SVV of observation group was higher at T3 than at T0,and the difference was statistically significant(p<0.05).HR and CO in the control group were smaller than those in the observation group at T1 and T2,and the difference was statistically significant(p < 0.05)(2)Compared with T0,the concentrations of IL-8and IL-10 in serum of the two groups were significantly higher(P < 0.05);compared with T0,the concentrations of IL-6 in the observation group were significantly higher(P< 0.05)at T1,T2,T3 and T4,and the concentrations of IL-6 in the control group were significantly higher(P < 0.05)at T2;compared with T0,the concentrations of CD4 + /CD3 +,CD4 + / CD8 + and CD8 + / CD3 + in the two groups were significantly higher(P < 0.05)Meaning(P < 0.05).The concentration of TNF-in the control group was significantly lower than that in the observation group at T1,T2,T3 and T4(P < 0.05).There was no significant difference in IL-6,CD4 + / CD3 +,CD4 + / CD8 + between the two groups at each time point(P > 0.05);at T4,the concentration of IL-10 in the control group was higher than that in the observation group,and CD8 + / CD3 + was lower thanthat in the observation group,with statistical significance(P < 0.05).(3)Compared with the control group,the recovery time of spontaneous respiration and extubation in the observation group was longer,the difference was statistically significant(P < 0.05);there was no significant difference between the two groups in the recovery time of orientation and hospitalization time(P > 0.05).There was no significant difference between the two groups(P > 0.05).Conclusion:In conclusion,during the thoracoscopic surgery,the immune function of both groups decreased for a short time,but recovered to normal soon;sevoflurane can obtain a more stable hemodynamic state compared with propofol group,at the same time,it can reduce the serum TNF-concentration and CD8 + / CD3 + level,increase the expression of IL-10,have a stronger anti-inflammatory effect,and have a more stress immunosuppressive effect on perioperative period It is small and safe for anesthesia of patients undergoing thoracoscopic surgery. |
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