胸腰筋膜平面阻滞对老年患者椎体后突成形术后镇痛及免疫功能的影响  

Effect of thoracolumbar interfascial plane block on analgesia and immune function after percutaneous kyphoplasty in elderly patients

作　　者：乔南南 潘阳阳 齐庆岭[2] 王效德[1] 苏涛[1] 徐桂萍[1] QIAO Nannan;PAN Yangyang;QI Qingling;WANG Xiaode;SU Tao;XU Guiping(Department of Anesthesiology,People s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,乌鲁木齐市830001 [2]天津中医药大学第一附属医院麻醉科

出　　处：《临床麻醉学杂志》2020年第10期958-961,共4页Journal of Clinical Anesthesiology

基　　金：新疆维吾尔自治区自然科学基金(2018D01C105)。

摘　　要：目的探讨超声引导下胸腰筋膜平面(TLIP)阻滞在老年患者椎体后突成形术后镇痛中的作用及对免疫功能的影响。方法择期行经皮后入路脊柱后突成形术老年患者100例,男41例,女59例,年龄70~90岁,ASAⅡ或Ⅲ级,采用随机数字表法分为两组:TLIP阻滞组(P组)和对照组(L组),每组50例。P组在超声引导下进行双侧TLIP阻滞,分别在两侧最长肌和髂肋肌之间注射0.375%罗哌卡因15 ml;L组不进行神经阻滞操作。记录麻醉诱导前、术后4、24、48 h T淋巴细胞亚群(CD3+、CD4+、CD8+)含量,计算CD4+/CD8+比值;记录术后4、12、24、48 h静息和运动时VAS疼痛评分。记录术中及术毕麻醉穿刺相关不良反应,如穿刺部位感染、血肿,局麻药中毒、神经损伤等。结果与麻醉前比较,术后4、24、48 h两组CD3+、CD4+含量和CD4+/CD8+比值明显升高(P<0.05)。与L组比较,术后4、24、48 h P组CD3+、CD4+含量明显升高,术后24、48 h P组CD4+/CD8+比值明显升高,术后4、12、24、48 h P组静息和运动时VAS疼痛评分明显降低(P<0.05)。两组均未见相关不良反应。结论在老年患者经皮后入路椎体后突成形术中,超声引导下胸腰筋膜平面阻滞可减轻术后疼痛并改善细胞免疫功能。Objective To explore the effect of ultrasound-guided thoracolumbar interfascial plane block on analgesia and immune function after percutaneous kyphoplasty in elderly patients.Methods A total of 100 elderly patients,41 males and 59 females,aged 70-90 years,falling into ASA physical statusⅡorⅢ,were selected to undergo elective posterior percutaneous kyphoplasty.Random number table method was used to divide the patients into two groups:the group with thoracolumbar interfascial plane block(group P)and control group(group L),50 patients in each group.Bilateral TLIP block was performed under ultrasound-guided in group P,and 0.375%ropivacaine 15 ml was injected between the longissimus and iliocostalis muscles on both sides.No nerve block was performed in group L.The levels of T lymphocyte subsets(CD3+,CD4+,CD8+)before anesthesia,4,24,and 48 h after surgery,and the CD4+/CD8+ratio were recorded.VAS scores of patients at rest and active states were recorded 4,12,24,and 48 h after surgery.The adverse reactions related to anesthesia puncture during and after the operation were recorded,such as infection at the puncture site,hematoma,local anesthetic poisoning,and nerve damage.Results Compared with those before anesthesia,CD3+,CD4+and CD4+/CD8+were all increased in the two groups 4,24 and 48 h after surgery(P<0.05).Compared with group L,CD3+and CD4+4,24 and 48 h after surgery,and the ratio of CD4+/CD8+24 and 48 h after surgery increased significantly in group P(P<0.05).The VAS pain scores in group P at rest and during exercise were significantly lower than those in group L after surgery.There were no obvious adverse reactions in both groups.Conclusion The thoracolumbar interfascial plane block has a certain significance in improving the analgesic effect and promoting the improvement of cellular immune function after posterior percutaneous kyphoplasty in elderly patients.

关 键 词：老年 胸腰筋膜平面阻滞 椎体后突成形术 镇痛效果 细胞免疫 

分 类 号：R614[医药卫生—麻醉学]