超声引导下胸椎旁神经阻滞复合全身麻醉对肺癌根治术患者的影响  

Effect of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia on patients undergoing resection for lung cancer

作　　者：崔婷婷[1] 周国庆[1] 陈东升[1] 周汝虹 CUI Ting-ting;ZHOU Guo-qing;CHEN Dong-sheng;ZHOU Ru-hong(Department of Anesthesiology,Beijing Pinggu District Hospital,Beijing 101200,China;Department of Anesthesiology,181th Hospital of Chinese PLA,Guilin 541002,China)

机构地区：[1]北京市平谷区医院麻醉科,北京101200 [2]解放军第181医院麻醉科,桂林541002

出　　处：《中国肿瘤临床与康复》2018年第12期1481-1484,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨超声引导下胸椎旁神经阻滞复合全身麻醉对肺癌根治术患者术后应激反应、免疫功能及炎性因子的影响。方法选取2015年2月至2017年6月间北京市平谷区医院收治的82例行择期手术治疗的肺癌患者为研究对象。将采用超声引导下胸椎旁神经阻滞复合全身麻醉治疗的41例患者纳入观察组,采用硬膜外阻滞复合全麻治疗的41例患者纳入对照组。密切关注两组患者在麻醉前、手术30min和术后1h患者的平均动脉压和心率的变化情况,同时密切观察两组患者白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、皮质醇、去甲肾上腺素及CD3+、CD4+、CD8+和CD4+/CD8+水平的变化。结果两组患者麻醉前的平均动脉压和心率比较,差异无统计学意义(P>0. 05)。观察组患者术后30min及术后1h的平均动脉压和心率均低于对照组患者,差异均有统计学意义(均P <0. 05)。两组患者术前的IL-6和IL-10比较,差异无统计学意义(P> 0. 05),但两组患者术后3h、术后24h和术后48h的IL-6和IL-10水平均明显升高,且观察组上述时间的IL-6和IL-10水平均低于对照组,差异均有统计学意义(均P <0. 05)。两组患者术前的皮质醇和去甲肾上腺素比较,差异无统计学意义(P>0. 05),但两组患者术后3h、术后24h和术后48h的皮质醇和去甲肾上腺素水平明显增加,且观察组上述时间的皮质醇和去甲肾上腺素均低于对照组,差异均有统计学意义(均P <0. 05)。两组患者的免疫球蛋白A(Ig A)比较,差异无统计学意义(P>0. 05)。观察组患者的免疫球蛋白M(Ig M)、免疫球蛋白G(Ig G)、CD4+、CD8+及CD4+/CD8+水平均明显高于对照组患者,差异均有统计学意义(均P <0. 05)。结论采用超声引导下胸椎旁神经阻滞复合全身麻醉对肺癌根治术患者术后免疫功能影响相对较小,同时可以减轻患者术后应激反应和炎性因子水平,改善患者预后及提高患者术后生活质量。Objective To investigate the effects of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia on postoperative stress response,immune function and inflammatory factors in patients with radical lung cancer. Methods From February 2015 to June 2017,82 patients who underwent elective surgery for lung cancer at Beijing Pinggu District Hospital were selected as the study subjects. Forty-one patients who were treated with ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia were included into the study group and 41 patients who were treated with epidural block combined with general anesthesia were included into the control group. The changes in mean arterial pressure and heart rate in the two groups before anesthesia,at 30 min and 1 h after operation were closely observed. Changes in interleukin 6( IL-6),IL-10,cortisol,norepinephrine and CD3^+,CD4^+,CD8^+and CD4^+/CD8^+levels were observed in the two groups. Results There is no significant difference in the mean arterial pressure and heart rate between the two groups before anesthesia( all P>0. 05). The mean arterial pressure and heart rate at 30 min and 1 h after operation were lower in the study group than in the control group( all P<0. 05). There was no significant difference in IL-6 and IL-10 between the two groups before the operation( all P<0. 05). However,at 3,24 and 48 h after the operation,IL-6 and IL-10 significantly increase in both groups and the levels of them were lower in the study group than in the control group( all P<0. 05). There was no significant difference in cortisol and norepinephrine before the operation( all P<0. 05). However,at 3,24 and 48 h after the operation,the levels of cortisol and norepinephrine increased in both groups with the study group lower than the control group( all P<0. 05). There was no significant difference in immunoglobulin A( Ig A) between the two groups( P>0. 05). However,Ig M,Ig G,,CD4+,CD8+and CD4+/CD8+levels were significantly higher in the study group th

关 键 词：超声引导 胸椎旁神经阻滞复合全麻 肺肿瘤 应激反应 免疫功能 炎性因子 

分 类 号：R734.2[医药卫生—肿瘤]