目的 探讨舒芬太尼复合丙泊酚靶控输注对宫颈癌根治术患者T细胞 17(Th17)/调节性 T 细胞(Treg)及氧化抗氧化系统的影响。方法 选取2019年10月-2021 年 10 月延安市人民医院行宫颈癌根治术患者 80 例为研究对象,采用随机数字表法分为对照组和试验组,每组各 40 例,两组患者均行全身麻醉下腹腔镜宫颈癌根治术治疗,术中对照组行芬太尼复合丙泊酚靶控输注;试验组行舒芬太尼复合丙泊酚靶控输注。比较两组麻醉前 1 h、麻醉后 1 h、手术结束后 1 h 血清 Th17/Treg 相关指标(Th17、Treg、Th17/Treg)、氧化抗氧化系统相关指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、过氧化氢酶(CAT)]水平,分别于术毕、术后 6 h、术后 12 h 对两组患者进行疼痛程度评分(VAS 评分)。结果 麻醉后 1 h、手术结束后 1 h 两组血清 Treg 水平均较麻醉前 1 h 显著降低(P<0.05),麻醉后 1 h、手术结束后 1 h 两组血清 Th17、Th17/Treg水平均较麻醉前 1 h 显著升高(P<0.05);试验组麻醉后 1 h、手术结束后 1 h 血清 Treg 水平高于对照组,Th17、Th17/Treg水平低于对照组(P<0.05);麻醉后 1 h、手术结束后 1 h 两组 SOD、CAT、MDA 水平均较麻醉前 1 h 升高,差异有统计学意义(P<0.05);试验组麻醉后 1 h、手术结束后 1 h 血清 SOD、CAT 水平高于对照组,MDA 水平低于对照组(P<0.05);试验组术后 6、12 h VAS 评分均显著低于对照组(P<0.05)。结论 与芬太尼复合丙泊酚靶控输注比较,宫颈癌患者根治术中采用舒芬太尼复合丙泊酚靶控输注能降低手术及麻醉对患者 Th17/Treg 及氧化抗氧化系统的影响,改善镇痛效果。

Objective To investigate effect of sufentanil compounded with propofol target-controlled infusion on T-cell 17 (Th17)/regulatory T cells (Treg) and oxidative-antioxidant system in patients undergoing radical cervical cancer surgery. Methods A total of 80 patients who underwent radical cervical cancer surgery in Yan'an People's Hospital from October 2019 to October 2021 were selected as the study subjects and randomly divided into two groups: 40 cases in the control group, who received fentanyl with propofol target-controlled infusion; 40 cases in the experimental group, who received sufentanil with propofol target-controlled infusion. The levels of Th17/Treg-related indexes (Th17, Treg, Th17/Treg), oxidative-antioxidant system-related indexes[superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT)] one hour before anesthesia, one hour after anesthesia and one hour after surgery., and pain level (VAS score) after surgery, six hours after surgery and 12 h after surgery were compared between two groups. Results The serum Treg levels in the two groups were significantly lower than those in the first hour after anesthesia and the first hour after surgery (P<0.05), and the serum Th17 and Th17/Treg levels in the two groups were significantly higher than those at one hour after anesthesia and one hour after surgery (P<0.05). Serum Treg levels were higher in the experimental group than in control group one hour after anesthesia and one hour after the end of surgery, and Th17 and Th17/Treg levels were lower than in control group (P<0.05). The levels of SOD, CAT and MDA in the two groups one hour after anesthesia and one hour after surgery were significantly higher than those one hour hour before anesthesia (P<0.05). Serum SOD and CAT levels were higher in experimental group than in control group one hour after anesthesia and one hour after the end of surgery, and MDA levels were lower than in control group (P<0.05). The VAS scores in experimental group were lower than those in control group at six hours and 12 h after surgery (P<0.05). Conclusion Compared with fentanyl combined with propofol target-controlled infusion, sufentanil combined with propofol target-controlled infusion in radical surgery for cervical cancer patients can reduce the effect on Th17/Treg and oxidative antioxidant system of patients and improve the analgesic effect.

R971

陕西省重点研发计划项目(2018SF-432)