术中肌肉松弛程度对腹腔镜肝脏肿瘤切除术患者术后免疫功能的影响  

Effect of intraoperative neuromuscular blockade depth on immune function of patients after laparoscopic liver tumor resection

作　　者：王娟[1] 魏国华[1] 黄河[1] WANG Juan;WEI Guohua;HUANG He(Department of Anesthesiology,First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,CHINA)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏210029

出　　处：《江苏医药》2020年第9期916-919,共4页Jiangsu Medical Journal

基　　金：江苏省青年医学重点人才(QNRC2016587);吴阶平医学基金会精准肌松项目(320-6750-18180)。

摘　　要：目的探讨术中肌肉松弛程度对腹腔镜肝脏肿瘤切除术后患者免疫功能的影响。方法行腹腔镜肝脏肿瘤切除术患者40例随机均分为中度肌肉松弛组(M组)和深度肌肉松弛组(D组)。术中维持目标肌肉松弛深度:M组4个成串刺激(TOF)计数为1~2个反应;D组单刺激肌颤搐计数为1~2个反应。分别于术前(T0)、术毕(T1)及术后第1天(T2)采集外周静脉血,流式细胞术检测CD3^+、CD4^+和CD8^+T淋巴细胞百分比,ELISA法检测血清免疫球蛋白(Ig)水平。评估两组手术质量,比较两组术后VAS疼痛评分及术后住院时间。结果与T0比较,T1、T2时两组CD3^+、CD4^+、CD8^+T淋巴细胞百分比及CD4^+/CD8^+比值均降低(P<0.05),D组CD3^+和CD4^+T淋巴细胞百分比及CD4^+/CD8^+比值高于M组(P<0.05)。与T0时比较,T1、T2时两组IgA、IgM和IgG水平降低(P<0.05),且M组IgA、IgM和IgG水平低于D组(P<0.05)。D组手术质量优于M组(P<0.05)。两组术后VAS疼痛评分相仿(P>0.05),但D组术后住院时间短于M组(P<0.05)。结论与中度肌肉松弛比较,术中维持深度肌肉松弛有利于腹腔镜肝脏肿瘤切除术后患者的康复,对免疫功能影响较小。Objective To explore the effect of intraoperative neuromuscular blockade depth on immune function of the patients after laparoscopic liver tumor resection.Methods Forty patients underwent laparoscopic liver tumor resection were equally divided into two groups,of whom moderate neuromuscular blockade was maintained(TOF 1 to 2 responses,group M)and deep neuromuscular blockade was maintained(post-tetanic counts 1-2 responses,group D)during operation.With flow cytometry and ELISA,the T cell percentages of CD3^+,CD4^+and CD8^+and serum levels of immunoglobulin(Ig)in peripheral venous blood were detected before operation(T0),immediately after operation(T1)and one day after operation(T2).The surgical quality,postoperative VAS pain score and hospital stay were compared between the two groups.Results Compared with T0,the T cell percentages of CD3^+,CD4^+,CD8^+and the ratio of CD4^+to CD8^+were reduced in both groups at T1 and T2(P<0.05).The T cell percentages of CD3^+and CD4^+T cells and the ratio of CD4^+to CD8^+at T1 and T2 were higher in group D than those in group M(P<0.05).Compared with T0,serum levels of IgA,IgM and IgG in both groups were decreased at T1 and T2(P<0.05),which in group M group were lower than those in group D(P<0.05).The quality of operation in group D was better than that in group M(P<0.05).VAS pain scores of both groups were similar(P>0.05),but the postoperative hospital stay in group D was shorter than that in group M(P<0.05).Conclusion Compared to moderate neuromuscular blockade depth,intraoperative deep neuromuscular blockade is helpful in promoting postoperative recovery of the patients undergoing laparoscopic liver tumor resection with little effect on postoperative immune function.

关 键 词：神经-肌肉阻滞 腹腔镜 肝癌 免疫功能 

分 类 号：R614[医药卫生—麻醉学]