Abstract: Objective  To investigate the anesthesia effects of different concentrations of sevoflurane combined with propofol during primary liver cancer resection surgery,as well as the changes in immune function in patients.Methods  Using single-blind method,120 cases of primary hepatocellular carcinoma admitted to the Third Affiliated Hospital of Naval Military Medical University from January 2023 to September 2023 were prospectively selected as the study subjects,and the patients were randomly (using the randomized numerical table method) included in the control group (60 cases) and the observation group (60 cases).During hepatic cancer resection,the control group was given 0.5 alveolar minimum effective concentration (MAC) sevoflurane combined with propofol target-controlled infusion anesthesia,and the observation group was given 1.0 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,and both groups were observed for 3 d postoperatively.The perioperative related indexes,the sedation and quality of awakening in the immediate moment of extubation,15 min after extubation,and 30 min after extubation,the cognitive function before and at 1 and 3 d postoperatively,vital signs before induction of anesthesia,after induction of anesthesia,at the moment of intubation,at the end of surgery,immune function before and 1 d postoperative,and adverse reactions during the observation period were compared between the two groups.Results The time for extubation,recovery of spontaneous respiration,recovery of orientation,and awakening in the observation group were (11.25±1.69) min,(9.76±1.34) min,(69.23±3.35) min,and (10.13±1.43) min,and the control group were (14.57±2.28) min,(13.55±2.76) min,(73.44±4.52) min,(14.26±2.25) min,all of which were shorter in the observation group than in the control group (P<0.05).The Ramsay sedation score at the immediate moment of extubation was (4.16±0.22) in the observation group,and (3.21±0.10) in the control group; the standardized (Aldrete) score in the awakening room of the observation group at the immediate moment of extubation,and 15 min after extubation were (9.56±0.12) and (9.77±0.20),respectively,and the control group was (9.02±0.13),respectively,(9.05±0.17) points; the scores of the brief mental state examination (MMSE) scale in the observation group were (26.23±1.12) points and (25.17±0.98) points in the control group in the 1 d postoperative period,which were higher than those of the control group (P<0.05).The heart rate (HR) at the moment of intubation and at the end of operation in the observation group were (73.08±4.10) beats/min,(75.27±6.03) beats/min,and the mean arterial pressure (MAP) was (81.56±4.49) mmHg and (86.07±5.48) mmHg,respectively,and in the control group the HR was (75.47±5.78) beats/min,(77.91±6.79) beats/min,and the MAP was (85.22±5.08) mmHg and (88.25±6.01) mmHg in the observation group,respectively,which were lower than those in the control group (P<0.05).The whole blood natural killer (NK) cells,CD4+ and CD4+/CD8+ in the observation group at 1 d postoperatively were (35.62±5.54)%,(50.09±3.32)%,and (1.42±0.25),the control group were (24.12±4.09)%,(43.17±4.20)%,and (1.20±0.19),the observation group was higher than the control group (P<0.05); whole blood CD8+ was (26.55±3.02)% in the observation group and (28.71±4.45)% in the control group,the observation group was lower than the control group (P<0.05).The total incidence of adverse reactions during the observation period was 16.67% in the observation group and 5.00% in the control group,which was higher than the control group (P<0.05).Conclusion Compared with 0.5 MAC sevoflurane combined with propofol target-controlled infusion anesthesia,1.0 MAC sevoflurane combined with propofol targetcontrolled infusion anesthesia had less effect on hemodynamics and immune function in patients undergoing resection for primary hepatocellular carcinoma,and it could improve the quality of patients’ awakening,cognitive function,and promote postoperative recovery,and the anesthesia was more effective,but it had more adverse effects.

Key words: primary liver cancer, hepatic resection, sevoflurane, propofol, immunologic function