超声引导椎旁阻滞对乳腺癌患者术后细胞免疫功能的保护作用  

Ultrasound-guided paravertebral blocks alleviate cellular immune dysfunction after modified radical mastectomy

作　　者：钱彬[1] 林芩[1] 陈亭亭[1] 陈丽君[1] QIAN Bin;LIN Qin;CHEN Ting-ting;CHEN Li-jun(Department of Anesthesiology,People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350004,China)

机构地区：[1]福建中医药大学附属人民医院麻醉科,福州350004

出　　处：《创伤与急诊电子杂志》2018年第4期198-202,共5页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省医学创新课题(2015-CXB-24);福建省中青年教师教育科研项目(JAT160234)

摘　　要：目的评估超声引导椎旁阻滞对乳腺癌改良根治术患者术后细胞免疫功能的保护作用。方法 80例择期行单侧乳腺癌改良根治手术患者随机分为椎旁组和对照组(n=40)。椎旁组患者全身麻醉诱导前行术侧T2～T6胸椎旁阻滞,每个节段注射0.5%罗哌卡因3 ml。两组患者均采用静脉全身麻醉,术毕行静脉自控镇痛。分别于麻醉前和术后48小时抽取静脉血样,采用流式细胞仪检测T淋巴细胞亚群(CD3^+、CD4^+、CD8^+)和NK细胞,并计算CD4^+/CD8^+值。记录术中瑞芬太尼用量、术后48小时静息状态疼痛程度、恶心呕吐和头晕等不良反应发生率以及患者满意度评分。结果术后48小时:椎旁组CD3^+T淋巴细胞高于对照组[(53.4±5.6)%v.s.(51.4±5.2)%,t=3.19,P<0.05];椎旁组CD4^+T淋巴细胞高于对照组[(29.4±3.1)%v.s.(22.6±2.9)%,t=4.78,P<0.05];椎旁组CD8^+T淋巴细胞高于对照组[(23.5±2.3)%v.s.(20.4±2.1)%,t=2.13,P<0.05];椎旁组NK细胞高于对照组[(11.8±1.3)%v.s.(10.1±1.2)%,t=3.17,P<0.05];椎旁组CD4^+/CD8^+比值高于对照组[(1.3±0.1) v.s.(1.1±0.1),t=1.63,P<0.05]。椎旁组术中瑞芬太尼用量为(0.05±0.02)μg/(kg·min),低于对照组(0.09±0.03)μg/(kg·min),差异有统计学意义(t=7.96,P <0.05)。与对照组比较,椎旁组患者术后48小时静息状态疼痛程度降低,舒芬太尼累积剂量减少,术后恶心呕吐发生率降低,患者满意度评分提高。结论超声引导椎旁阻滞可保护乳腺癌患者术后细胞免疫功能,减轻术后疼痛程度,同时减少术后恶心呕吐等不良反应,有利于患者术后康复和转归。Objective To evaluate the effects of ultrasound-guided paravertebral blocks (PVB) on the postoperative cellular immune function after modified radical mastectomy undergoing general anesthesia. Methods Eighty patients with American Society of Anesthesiologists (ASA) physical status I or II undergoing modified radical mastectomy were randomly allocated to PVB group or control group. The PVB group received T2 ~ T6 PVBs with 3 ml of 0.5% ropivacaine per level, whereas the control group did not receive PVB. The primary outcome was the cellular immune function, which was assessed on the day before surgery and 48 h after surgery by flow cytometry. Secondary outcomes included postoperative rest pain intensity, the incidence of postoperative nausea and vomiting (PONV), as well as the patient’s satisfaction. Results Compared with the control group, the levels of CD3+, CD4+, CD8+, CD4+/ CD8+ were increased in the PVB group at postoperative 48 h (all P<0.05). Simultaneously, the level of natural killer cell was increased in the PVB group compared to the control group at postoperative 48 h [(11.8±1.3)% v.s.(10.1±1.2)%, P<0.05]. In addition, the postoperative pain intensity at rest and the cumulative doses of sufentanil were both lower in the PVB group. Ultrasound-guided multi-level paravertebral blocks also reduced the incidence of PONV (from 52.5% to 15%, P<0.05) and improved the patient’s satisfactory scores. Conclusions Ultrasoundguided multi-level paravertebral blocks can enhance the cellular immune function, postoperative analgesia and patient’s satisfaction after general anesthesia for modified radical mastectomy.

关 键 词：超声引导 椎旁神经阻滞 细胞免疫功能 术后疼痛 乳腺癌改良根治术 

分 类 号：R614.4[医药卫生—麻醉学] R737.9[医药卫生—外科学]