Effects Of Propofol And Sevoflurane On Cellular Immune Function And Postoperative Complications In Patients With Nsclc Undergoing Surgery

Objective:We explore the effects of propofol and sevoflurane on the immunity and postoperative complications of patients undergoing thoracoscopic non-small cell lung cancer（NSCLC）radical surgery,and provide advisable anesthesia for patients with NSCLC television-assisted thoracoscopic surgery（VATS）.Methods:Sixty-one patients with NSCLC undergoing general anesthesia and VATS from May to October 2019 at the Guangxi Medical University Affiliated Tumor Hospital,were selected as our cases.They were divided into two groups by random number table,30 of which were in Group Propofol（Group P）and 31 were in Group Sevoflurane（Group S）.Midazolam,propofol,fentanyl,and cis-atracuramide were injected into both groups during induction of anesthesia.Propofol,remifentanil,and cis-atracuramide were used for maintenance of anesthesia in Group P.Sevoflurane,remifentanil,and cis-atracuramide were used for another group.Hemodynamics and related anesthetic doses were recorded during perioperative period.Neutrophils（NEU）and lymphocytes（LYM）absolute numbers,total T lymphocytes（CD3⁺）,helper lymphocytes（CD4⁺）,suppressor lymphocytes（CD8⁺）,natural killer cells（NK）,B lymphocytes,CD4⁺/CD8⁺ratio,and cytokines lnterleukin 1β（IL-1β）,tumor necrosis factorα（TNF-α）were measured in two groups of patients before surgery（T0）,postoperative 24 hour（T1）,postoperative 72 hour（T2）,postoperative day 7（T3）.Postoperative liver and kidney function,postoperative pulmonary infection,pneumothorax,and pleural effusion were evaluated in two groups.RESULTS:Comparisons of the mean arterial pressure（MAP）and heart rate（HR）under anesthesia in patients with NSCLC between groups,Group P were more smoothly than Group S at one-lung ventilation（OLV 1h）and two-lung ventilation 30 minutes（TLV 30min）（p<0.05）.The recovery time and extubation time were significantly longer in the Group S than Group P（p<0.05）.Comparison of the NEU between groups:Group P were significantly lower than Group S at T3（p<0.01）.Intra-group comparison:Compared with T0,NEU were significantly increased at T1～T3（p<0.01）.Comparison of the LYM between groups:Group P were significantly higher than Group S at T1 and T2（p<0.01）,and CD8⁺proportion were the most significant（p<0.05）.Intra-group comparison:T1 and T2 LMY were significantly lower than T0（p<0.01）.CD3⁺intra-group comparison:T1 and T2 were significantly lower than T0 in Group P and Group S（p<0.01）.Intra-group comparison of CD4⁺:T1 and T0 were significantly decreased in both Group P and Group S（p<0.01）.Comparison of the CD8⁺between groups:Group P were significantly higher than Group S at T1,T2 and T3（p<0.05）.Intra-group comparison:T2 and T3 in Group S were significantly lower than T0（p<0.05）.NK cells were significantly higher in Group P than in Group S at T3（p<0.05）.Intra-group comparison:T1 were significantly higher than T0,T3 were significantly lower than T0（p<0.01）.In Group S,T1 was significantly higher than T0,T3 were significantly lower than T0（p<0.01）.Comparison in B cell group:T1,T2 and T3 in Group P and Group S were significantly increased compared with T0（p<0.05）.Comparison of CD4⁺/CD8⁺between groups:Group P were significantly lower than Group S at T2 and T3（p<0.01）.Intra-group comparison:T1 was significantly lower than T0 in Group P（p<0.05）.T2 and T3 in Group S were significantly higher than T0（p<0.05）.Analysis of the cellular immune function of stage I patients after anesthesia with propofol(Group P_{I stage})or sevoflurane(Group S_{I stage}):Compared with CD8⁺,T0 was significantly reduced at T2 and T3 in The S_{I stage}（p<0.05）,while T1,T2 and T3 showed a decreasing trend.NK cells in Group P_{I stage}and Group S_{I stage}showed a decreasing trend at T2 and T3.At T1,T2 and T3,B cells in Group P_{I stage}and Group S_{I stage}showed an upward trend.The increase of TNF-αwas more significant in Group S than in Group P at T2and T3（p<0.05）.Compared with the preoperative group,Group P and Group S were significantly increased at each time point（p<0.01）.There was no significant difference of IL-?between Group P and Group S at each time point（p>0.05）.Compared with the preoperative group,Group P and Group S were significantly increased at each time point（p<0.05）.Both general anesthetic drugs caused a slight effect on liver or kidney function in patients.However,comparison of the incidence of pleural effusion between groups,Group P were significantly higher than Group S at T3（p<0.05）as well as the postoperative hospital stays were significantly shorter in the Group S than the Group P（p<0.05）.CONCLUSIONS:The hemodynamics of the propofol using during anaesthesia were more stable,their postoperative recovery were faster than sevoflurane anesthesia.During the perioperative period,the postoperative immune system of the patients were inhibited to varying degrees,propofol was less severe than sevoflurane.