静脉全麻复合颈丛神经阻滞及术后镇痛对颈淋巴结结核患者术后呼吸、循环及T细胞亚群的影响  

Effect of intravenous general anesthesia combined with cervical plexus block and postoperative analgesia on postoperative respiration,circulation,and T-lymphocyte subsets in patients with cervical lymph tuberculosis

作　　者：张绍刚[1] 潘熊熊[2] 季娟[1] 于淑侠[1] 钮晓红[3] 钱燕宁[2] 

机构地区：[1]南京市中西医结合医院麻醉科,210014 [2]南京医科大学第一附属医院麻醉科 [3]南京市中西医结合医院瘰疬科,210014

出　　处：《临床麻醉学杂志》2010年第11期947-949,共3页Journal of Clinical Anesthesiology

基　　金：南京市科技发展基金(QYK09190)

摘　　要：目的观察静脉全麻复合颈丛神经阻滞及术后镇痛对颈淋巴结结核患者术后呼吸、循环及T细胞亚群的影响。方法选择60例ASAⅠ或Ⅱ级择期行颈淋巴结结核病灶清除术的患者,随机均分为三组:A组(静脉全麻复合颈丛神经阻滞+患者自控颈丛镇痛),B组〔静脉全麻复合颈丛神经阻滞+患者自控静脉镇痛(PCIA),C组(静脉全麻+PCIA)。测定麻醉前30min(T0)、术后4h(T1)、24h(T2)、2d(T3)、3d(T4)外周静脉血T淋巴细胞亚群CD3+、CD4+、CD8+百分比;观察T0～T3时VT、肺活量(Vc)、RR、SpO2、MAP和HR;记录T1～T3时疼痛、镇静评分。结果 T1、T2时三组患者CD3+、CD4+、CD4+/CD8+均明显下降(P<0.05);A组T4时各免疫指标恢复至术前水平;B组和C组T1时RR较T0时明显增快(P<0.05),而T2时SpO2、Vc均较T0时明显下降(P<0.05),A组T1时RR低于B、C组(P<0.05),而VT高于B、C组(P<0.05),A组T1、T2时Vc、SpO2均高于B、C组(P<0.05);A组术后T1～T3时MAP、HR均无明显改变。结论静脉全麻复合颈丛神经阻滞及术后镇痛可减轻颈淋巴结结核患者术后免疫功能的抑制,并改善呼吸、循环功能。Objective To investigate the effect of intravenous general anesthesia （IGA） combined with cervical plexus block and postoperative analgesia on postoperative respiration,circulation,and T-lymphocyte subsets in patients with cervical lymph tuberculosis. Methods Sixty patients,ASA Ⅰ or Ⅱ,scheduled for cervical lymph tuberculosis surgery were randomized into A （IGA combined with cervical plexus block and patient-control cervical plexus analgesia）,B [IGA combined with cervical plexus block and postoperative intravenous analgesia （PCIA）],and C （IGA and PCIA） groups. Peripheral blood samples were obtained to detect the percent of T-lymphocyte subsets （CD3＋,CD4＋,CD8＋,CD4＋/CD8＋） by flow cytometry at the following time points：30 min before anesthesia induction （T0）,and 4 h （T1）,24 h （T2）,2 d （T3）,3 d （T4） after surgery. Tidal volume （VT）,vital capacity （Vc）,respiratory rate （RR）,SpO2,MAP,and HR were observed at T0-T3. Pain and sedation scores were recorded at T1-T3.Results CD3＋,CD4＋ and CD4＋/CD8＋ decreased significantly in the three groups at T1 and T2 （P0.05）,which retrieved the preoperative level in group A at T4. RR was faster than preoperative level in groups B and C at T1 （P0.05）. SpO2,and Vc decreased comparing to the preoperative level in groups B and C at T2 （P0.05）. RR and VT were lower and higher in group A than those in groups B and C at T1,respectively （P0.05）. Vc and SpO2 were higher in group A than in groups B and C at T1 and T2. MAP and HR had no significant changes in group A at T1-T3 after surgery.Conclusion IGA combined with cervical plexus block and postoperative analgesia may mitigate postoperative immune depression and ameliorate respiration and circulation function in patients with cervical lymph tuberculosis.

关 键 词：颈丛神经阻滞 静脉全麻 术后镇痛 颈淋巴结结核 

分 类 号：R614[医药卫生—麻醉学]