胸椎旁神经阻滞复合全身麻醉联合静脉自控镇痛对老年肺癌根治术患者血流动力学、氧化应激及细胞因子的影响  

Effects of thoracic paravertebral block combined with general anesthesia and intravenous patient-controlled intravenous analgesia on hemodynamics,oxidative stress and cytokines in elderly patients undergoing radical operation of lung cancer

作　　者：彭要要 刘守知 张建国 PENG Yaoyao;LIU Shouzhi;ZHANG Jianguo(Department of Cardiothoracic Surgery,General Hospital of Pingmei Shenma Medical Group,Pingdingshan 467000,He’nan,China)

机构地区：[1]平煤神马医疗集团总医院胸心外科,河南平顶山467000

出　　处：《癌症进展》2021年第20期2109-2113,共5页Oncology Progress

摘　　要：目的分析胸椎旁神经阻滞(TPVB)复合全身麻醉联合静脉自控镇痛(PCIA)对老年肺癌根治术患者血流动力学、氧化应激及细胞因子的影响。方法将98例行胸腔镜肺癌根治术的老年患者按麻醉方式分为A(n=56)、B组(n=42),A组应用单纯全身麻醉联合PCIA自控镇痛,B组采用TPVB复合全身麻醉联合PCIA镇痛。比较两组患者手术前后不同时间点血流动力学指标[心率(HR)、平均动脉压(MAP)]、氧化应激指标[去甲肾上腺素(NE)、皮质醇(Cor)、血糖];记录两组患者术后不同时间视觉模拟法(VAS)评分的变化;统计两组患者术后24 h镇痛情况(PCIA泵按压次数及镇痛药物用量);测定术前、术后48 h两组患者肺功能指标[第一秒用力呼吸容积(FEV_(1))、用力肺活量(VC)、每分钟最大通气流量(MVV)、最大呼气中段流量(MMF)]及细胞因子水平[CD3^(+)、CD4^(+)、CD8^(+)、自然杀伤(NK)细胞、白细胞介素-6(IL-6)、转化生子因子-β1(TGF-β1)]。结果B组患者胸腔镜套管置入5 min(T_(1))、拔管时(T_(2))、拔管后30 min(T_(3))、术毕6 h(T_(4))的HR、NE、Cor及血糖均低于A组,T_(1)、T_(2)、T_(4)点MAP均低于A组(P﹤0.05)。B组患者术后不同时间VAS评分均低于A组(P﹤0.05)。B组患者术后24 h PCIA按压次数、瑞芬太尼用量、地佐辛用量均少于A组(P﹤0.05)。B组患者术后48 h FEV_(1)、VC、MVV、MMF均高于A组(P﹤0.05)。B组患者术后48 h CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平高于A组,IL-6、TGF-β1均低于A组(P﹤0.05)。两组患者不良反应发生情况比较,差异无统计学意义(P﹥0.05)。结论TPVB复合全身麻醉联合PCIA用于老年肺癌根治术中可减少患者血流动力学波动,减轻氧化应激反应及机体免疫抑制,降低炎症反应,提高镇痛效果,促进术后肺功能恢复。Objective To analyze the effects of thoracic paravertebral block(TPVB)combined with general anesthesia and patient-controlled intravenous analgesia(PCIA)on hemodynamics,oxidative stress and cytokines in elderly patients undergoing radical operation of lung cancer.Method A total of 98 elderly patients undergoing thoracoscopic radical operation of lung cancer were divided into group A(n=56)and group B(n=42)according to the anesthesia method.Group A was given general anesthesia combined with PCIA,and group B was given TPVB combined with general anesthesia and PCIA.The hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)]and oxidative stress indexes[norepinephrine(NE),cortisol(Cor)and blood glucose]were compared between the two groups before and after surgery.The changes in visual analogue scale(VAS)scores at different time after surgery were recorded.The frequency of PCIA pump presses and the amount of analgesic drugs were measured at 24h after surgery.The pulmonary function indicators[forced expiratory volume in one second(FEV_(1)),forced vital capacity(VC),maximum ventilation volume per minute(MVV),maximum mid-expiratory flow(MMF)]and various cytokines[CD3^(+),CD4^(+),CD8^(+),natural killing cells(NK),interleukin-6(IL-6),transforming factor-β1(TGF-β1)]were measured in the two groups before surgery and at 48 h after surgery.The incidence rate of adverse events was counted.Result The levels of HR,NE,Cor and blood glucose in group B were lower than those of group A at thoracoscopic cannula placement for 5 min(T_(1)),extubation tim(T_(2)),after extubation for 30 min(T_(3)),and after operation 6 h(T_(4)),the levels of MAP in goup B lower than those of group A at T_(1),T_(2) and T_(4)(P<0.05).The VAS scores of group B lower than those of group A at different time points after surgery(P<0.05).The pressing frequency of PCIA pump,dosage of remifentanil and dosage of dezocine in group B at 24 h after surgery were all lower than those in group A(P<0.05).The levels of FEV_(1),VC,MVV and MMF in group B were higher

关 键 词：肺癌根治术 胸椎旁神经阻滞 血流动力学 应激反应 

分 类 号：R734.2[医药卫生—肿瘤]