Effect comparison of sevoflurane and propofol on cognitive function, respiratory and circulatory function and stress response in patients undergoing laparoscopic radical gastrectomy
10.3760/cma.j.cn115355-20231215-00238
- VernacularTitle:七氟烷与丙泊酚麻醉对腹腔镜胃癌根治术患者认知功能、呼吸循环功能及应激反应影响的比较
- Author:
Jianchun GENG
1
;
Yan ZHU
;
Jing WANG
Author Information
1. 凉山彝族自治州中西医结合医院麻醉科，西昌 615000
- Keywords:
Stomach neoplasms;
Laparoscopes;
Surgical procedures, operative;
Anesthesia;
Sevoflurane;
Propofol
- From:
Cancer Research and Clinic
2024;36(7):525-531
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of sevoflurane and propofol on cognitive function, respiratory and circulatory function, and stress response in patients undergoing laparoscopic radical gastrectomy.Methods:A prospective randomized controlled study was conducted. A total of 116 patients who underwent laparoscopic radical gastric cancer surgery in Liangshan Yi Autonomous Prefecture Hospital of Integrated Chinese and Western Medicine from January 2021 to January 2022 were selected, and all patients were divided into the propofol group and the sevoflurane group according to the random number table method, with 58 cases in each group. Propofol anesthesia was used in the propofol group and sevoflurane anesthesia was used in the sevoflurane group. The anesthesia-related indexes and respiratory and circulatory function indexes, oxidative stress parameters and cognitive function indexes neuron-specific enolase (NSE) levels, Mini-Mental State Examination (MMSE) scale score, and complications at different time points were compared between the 2 groups.Results:There were no statistically significant differences in the baseline data between the 2 groups (all P > 0.05). The differences in intraoperative bleeding, pneumoperitoneum time and anesthesia onset time between the 2 groups were not statistically significant (all P > 0.05); eye opening time [(13.2±2.6) min vs. (17.6±3.7) min] and respiratory recovery time [(12.6±2.2) min vs. (16.5±2.3) min] of patients in the sevoflurane group were shorter than those in the propofol group, and the differences were statistically significant ( t values were 7.41 and 9.31, respectively, both P < 0.001). Repeated measurement analysis of variance showed that the temporal, intergroup and temporal-intergroup interaction differences in heart rate, mean arterial pressure and oxygen saturation before induction of anesthesia, immediately after induction of anesthesia, and at the time of anesthesia duration of 10 min, anesthesia duration of 20 min, and anesthesia duration of 30 min between the propofol group and the sevoflurane group were not statistically significant (all P>0.05). The temporal, intergroup and temporal-intergroup interaction differences in the oxidative stress indexes of blood glucose, adrenaline, adrenocorticotropin, and cortisol between the 2 groups were statistically significant (all P < 0.001). The levels of blood glucose, epinephrine, adrenocorticotropin and cortisol in the sevoflurane group were lower than those in the propofol group immediately after induction of anesthesia, and at the time of anesthesia duration of 10 min, anesthesia duration of 20 min, and anesthesia duration of 30 min. The level of NSE before anesthesia in the propofol group and the sevoflurane group was (6.6±0.8) ng/ml and (6.5±0.7) ng/ml, respectively, and there was no statistically significant difference ( P > 0.05). The level of NSE in the sevoflurane group was higher than that in the propofol group immediately after surgery [(8.9±0.8) ng/ml vs. (8.2±0.9) ng/ml], 6 h after surgery [(10.2±1.2) ng/ml vs. (9.5±1.0) ng/ml], and 24 h after surgery [(9.3±1.1) ng/ml vs. (8.2±0.9) ng/ml] and 48 h after surgery [(8.7±0.9) ng/ml vs. (8.1±0.9) ng/ml]; and there were temporal, intergroup and temporal-intergroup interaction differences in NSE level of the 2 groups (all P < 0.001). The MMSE score in the sevoflurane group was lower than that in the propofol group immediately after surgery, 6 h after surgery, 24 h after surgery, 48 h after surgery, the temporal, intergroup and temporal-intergroup interaction differences in MMSE scale score of the 2 groups were statistically significant (all P < 0.001). The incidence of postoperative complications in the propofol group and the sevoflurane group was 24.1% (14/58) and 25.9% (15/58), respectively, and the difference was statistically significant ( χ2 = 2.12, P = 0.833). Conclusions:Sevoflurane and propofol anesthesia have no significant effect on the respiratory and circulatory functions of patients undergoing laparoscopic radical surgery for gastric cancer, whereas propofol has a smaller effect on cognitive functions, and sevoflurane inhibits oxidative stress better. Both of them are worthy of clinical application.
