【摘要】 目的 探究依托咪酯或丙泊酚麻醉对腹腔镜胃肠肿瘤根治术老年患者术后疼痛、应激反应及免疫功能的影响。方法 前瞻性选取2019年1月至2020年12月广西壮族自治区民族医院收治的85例老年胃肠肿瘤患者为研究对象，按照随机数字表法分为依托咪酯组（n=43）和丙泊酚组（n=42）。依托咪酯组予以依托咪酯0.2～0.3 mg/kg麻醉诱导，术中予以依托咪酯6～8μg·kg^-1·min^-1持续输注；丙泊酚组予以丙泊酚1～2 mg/kg麻醉诱导，术中予以丙泊酚2～4 mg·kg^-1·h^-1持续输注。两组麻醉维持均予以瑞芬太尼0.2μg·kg^-1·min^-1输注。记录两组手术一般情况，评估两组患者术后30 min、1 h、3 h、6 h、12 h、24 h、48 h的视觉模拟评分法（VAS）评分，记录术后24 h内自控静脉镇痛（PCIA）按压次数及镇痛补救率，检测两组患者术前及术后24 h时皮质醇、醛固酮、丙二醛、T淋巴细胞、CD4⁺/CD8⁺、NK细胞水平。结果 依托咪酯组VAS评分在术后30 min、1 h、3 h时分别为（2.83±0.82）、（3.32±1.22）、（3.74±1.20）分，均明显低于丙泊酚组[（3.61±1.28）、（4.04±1.05）、（4.83±1.33）分],差异均有统计学意义（P<0.05）,术后6～48 h时两组VAS评分及PCIA按压次数、镇痛补救率比较，差异均无统计学意义（P>0.05）。术后24 h,两组皮质醇、醛固酮、丙二醛水平均较术前升高，而依托咪酯组皮质醇、醛固酮、丙二醛水平分别为（368.69±18.24） ng/mL、（343.34±16.87） ng/mL、（4.08±1.07） pg/mL,均显著低于丙泊酚组[（394.54±19.11） ng/mL、（377.95±18.64） ng/mL、（6.12±1.14） pg/mL],差异均有统计学意义（P<0.05）。术后24 h,丙泊酚组T淋巴细胞、CD4⁺/CD8⁺、NK细胞水平均较术前明显降低，差异均有统计学意义（P<0.05）,而依托咪酯组T淋巴细胞、CD4⁺/CD8⁺、NK细胞水平则无明显变化（P>0.05）,且依托咪酯组分别为（67.32±4.85）%、1.76±0.47、（16.73±2.75）%,显著高于丙泊酚组[（65.36±3.97）%、1.53±0.44、（14.82±2.66）%],差异均有统计学意义（P<0.05）。结论 依托咪酯麻醉相较于丙泊酚可减轻腹腔镜胃肠肿瘤根治术老年患者术后疼痛程度，应激反应较轻，且对免疫功能影响小。更多还原

【Abstract】 Objective To explore the effects of etomidate or propofol anesthesia on postoperative pain, stress response and immune function in elderly patients undergoing laparoscopic radical gastrectomy. Methods A total of 85 cases of elderly patients with gastrointestinal cancer admitted to Ethnic Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2020 were prospectively selected and divided into etomidate group（n=43） and propofol group（n=42） according to random number table method. The etomidate group was given etomidate 0.2-0.3 mg/kg anesthesia induction, and etomidate was continuously infused at 6-8 μg·kg^-1·min^-1 during the operation. Propofol group was given propofol 1-2 mg/kg anesthesia induction, and propofol 2-4 mg·kg^-1·h^-1 continuous infusion during operation. Anesthesia was maintained with remifentanil 0.2 μg·kg^-1·min^-1 infusion in both groups. The visual analogue scale（VAS） score was evaluated at 30 min, 1 h, 3 h, 6 h, 12 h, 24 h and 48 h after operation, the number of patient controlled intravenous analgesia（PCIA） compressions and analgesic rescue rate within 24 h after operation were recorded, the levels of cortisol（Cor）, aldosterone（ALD）, malondialdehyde（MDA）, T lymphocyte, CD4⁺/CD8⁺ and NK cell were detected before operation and 24 h after operation. Results The VAS scores of etomidate group at 30 min, 1 h, 3 h after operation were（2.83±0.82）,（3.32±1.22）,（3.74±1.20） points, respectively, which were significantly lower than that of propofol group[（3.61±1.28）,（4.04±1.05）,（4.83±1.33） points], the differences were statistically significant（P<0.05）, and there was no statistically significant difference in VAS score at 6-48 h, PCIA pressing times and analgesic rescue rate（P>0.05）. At 24 h after operation, the levels of Cor, ALD and MDA in the two groups increased, while those in the etomidate group were（368.69±18.24） ng/mL,（343.34±16.87） ng/mL,（4.08±1.07） pg/mL, respectively, which were significantly lower than those in the propofol group[（394.54±19.11） ng/mL,（377.95±18.64） ng/mL,（6.12±1.14） pg/mL], the differences were statistically significant（P<0.05）. At 24 h after operation, the levels of T lymphocytes, CD4⁺/CD8⁺ and NK cells in propofol group were significantly lower than those before operation, the differences were statistically significant（P<0.05）, while those in etomidate group had no statistically significant change（P>0.05）, and those in etomidate group were（67.32±4.85）%, 1.76±0.47,（16.73±2.75）%, respectively, which were significantly higher than those in the propofol group [（65.36± 3.97）%, 1.53±0.44,（14.82±2.66）%], the differences were statistically significant（P<0.05）. Conclusion Compared with propofol, etomidate anesthesia can significantly reduce postoperative pain, stress response and immune function.更多还原