超声引导下两点胸椎旁神经阻滞用于腔镜手术对患者应激水平和免疫功能的影响  

Effect of ultrasound-guided double level thoracic paravertebral block on stress level and immune function in patients undergoing endoscopic surgery

作　　者：方家佳 李元海[1] FANG Jia-jia;LI Yuan-hai(Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230022

出　　处：《临床和实验医学杂志》2020年第24期2679-2683,共5页Journal of Clinical and Experimental Medicine

基　　金：安徽省科技攻关计划项目(编号:1301042204)。

摘　　要：目的探讨超声引导下两点胸椎旁神经阻滞用于腔镜手术对患者应激水平和免疫功能的影响。方法前瞻性选取安徽医科大学第一附属医院2017年9月至2018年9月收治的行胸腔镜下肺癌切除术患者85例,采用随机数字表法将其分为对照组42例和观察组43例。对照组患者采用全身麻醉,观察组患者在全身麻醉基础上复合两点胸椎旁神经阻滞。比较2组患者醉诱导前(T0)、单肺通气1 h(T1)、通气结束(T2)、术毕即刻(T3)、术后2 h(T4)的血流动力学[心率、平均动脉压(MAP)],术后1、4、8 h疼痛情况,术前、术后1 d应激水平[丙二醛(MDA)和醛固酮(ADS)],免疫功能和不良反应。结果2组患者在T0、T1、T2、T3、T4时刻心率、MAP比较,差异均无统计学意义(P>0.05);术后1 h,2组患者VAS评分比较,差异无统计学意义(P>0.05),术后4、8 h,观察组VAS评分明显低于对照组[(2.02±1.10)分vs.(2.55±1.23)分、(2.07±1.08)分vs.(2.64±1.30)分],差异有统计学意义(P<0.05);术前2组患者血清ADS、MDA水平比较,差异无统计学意义(P>0.05),术后1 d,观察组ADS、MDA水平低于对照组[(125.74±4.72)nmol/mL vs.(143.29±20.72)nmol/mL、(5.90±0.86)U/mL vs.(7.92±0.82)U/mL],差异有统计学意义(P<0.05);观察组CD4+、CD4+/CD8+水平均高于对照组[(31.31±0.91)%vs.(28.53±0.89)%,(1.27±0.26)vs.(1.12±0.28)],CD8+水平低于对照组[(24.65±0.86)%vs.(25.44±1.02)%],差异有统计学意义(P<0.05);观察组不良反应发生率(9.30%)低于对照组(21.43%),差异有统计学意义(P<0.05)。结论对腔镜手术患者采用超声引导下两点胸椎旁神经阻滞可显著减轻患者疼痛,降低应激反应,改善免疫功能,降低不良反应发生率,值得临床推广。Objective To investigate the effect of ultrasound-guided double level thoracic paravertebral block on stress level and immune function in patients undergoing endoscopic surgery.Methods Eighty-five patients underwent thoracoscopic lung cancer resection in the First Affiliated Hospital of Anhui Medical University from September 2017 to September 2018 were selected and divided two groups by random number table.The control group(n=42)were received general anesthesia,while the observation group(n=43)were received general anesthesia combined with ultrasound-guided double level thoracic paravertebral block.Then the hemodynamics[heart rate,mean dynamic pressure(MAP)]at Before induction(T0),one-lung ventilation for 1 hour(T1),end of ventilation(T2),immediately after operation(T3),2 hours after operation(T4),pain at 1,4,8 h after operation,stress level[malondialdehyde(MDA)and Aldosterone(ADS)]before operation and 1 d after operation,immune function,and adverse reactions were compared between groups.Results HR and MAP at T0,T1,T2,T3,and T4 had no significant difference between groups(P>0.05).There was no significant difference in VAS scores between the two groups at 1 hour after operation(P>0.05),VAS score of observation group was significantly lower than that of control group at 4 hours and 8 hours after operation[(2.02±1.10)scores vs.(2.55±1.23)scores,(2.07±1.08)scores vs.(2.64±1.30)scores],the differences were statistically significant(P<0.05).There was no significant difference in serum ADS and MDA levels between the two groups before surgery(P>0.05),ADS and MDA levels at postoperative 1 d in observation group were lower than those in control group[(125.74±4.72)nmol/mL vs.(143.29±20.72)nmol/mL,(5.90±0.86)U/mL vs.(7.92±0.82)U/mL],the differences were statistically significant(P<0.05).CD4+and CD4+/CD8+levels at postoperative 1d in observation group were higher than those in control group[(31.31±0.91)%vs.(28.53±0.89)%,(1.27±0.26)vs.(1.12±0.28)],CD8+level was lower than the control group[(24.65±0.86)%vs.(25.44�

关 键 词：两点胸椎旁神经阻滞 腔镜手术 应激水平 免疫功能 

分 类 号：R614[医药卫生—麻醉学]