胸段硬膜外阻滞与胸椎旁阻滞对肺癌开胸手术患者肺功能及炎症因子的影响  

Effects of Thoracic Epidural Block and Paravertebral Block on Pulmonary Function and Inflammatory Factors in Patients with Lung Cancer Undergoing Thoracotomy

作　　者：康颖颖 郑韶 周彪 KANG Yingying;ZHENG Shao;ZHOU Biao(Department of Anesthesiology,Luoyang Central Hospital,Luoyang 471000,China)

机构地区：[1]洛阳市中心医院麻醉科,河南洛阳471000

出　　处：《河南医学研究》2021年第34期6403-6405,共3页Henan Medical Research

摘　　要：目的比较胸段硬膜外阻滞与胸椎旁阻滞对肺癌开胸手术患者肺功能及炎症因子白细胞介素-6(IL-6)、白细胞介素-10(IL-10)的影响。方法选取2019年2月至2020年12月于洛阳市中心医院接受开胸手术的68例肺癌患者作为研究对象,采用随机数表法分为A、B两组,每组34例。A组接受胸段硬膜外阻滞,B组接受胸椎旁阻滞。观察两组患者麻醉前、术毕、术后30 min、术后6 h IL-6、IL-10水平。比较两组术前1 d及术后6、12、24、48 h肺功能指标。比较两组并发症发生情况。结果两组术毕、术后30 min、术后6 h IL-6、IL-10水平升高,差异有统计学意义(P<0.05);A组术毕IL-6水平低于术后30 min(P<0.05);两组术毕IL-10水平低于术后30 min(P<0.05)。两组术前1 d的用力肺活量占预计值百分比(FVC%)、1秒用力呼气容积占预计值百分比(FEV_(1)%)、1秒用力呼气容积占用力肺活量比值(FEV_(1)/FVC)高于术后6、12、24、48 h(P<0.05);术后12、24、48 h时A组FVC%、FEV_(1)%低于B组(P<0.05)。A组并发症总发生率高于B组(P<0.05)。结论肺癌患者经胸椎旁阻滞或胸段硬膜外阻滞后接受开胸手术均可出现不同程度的炎症反应,但胸椎旁阻滞对患者肺功能损伤较轻,患者术后并发症发生率低,利于预后。Objective To compare the effects of thoracic epidural block and paravertebral block on lung function and inflammatory factors interleukin-6(IL-6)and interleukin-10(IL-10)in patients with lung cancer undergoing thoracotomy.Methods A total of 68 patients with lung cancer who underwent thoracotomy in Luoyang Central Hospital from February 2019 to December 2020 were selected as the research objects.They were randomly divided into groups A and B,with 34 cases in each group.Group A received thoracic epidural block and group B received thoracic paravertebral block.The levels of IL-6 and IL-10 were observed before anesthesia,after operation,30 mins and 6 hours after operation.The pulmonary function indexes of the two groups were compared 1 day before operation and 6,12,24 and 48 hours after operation.The complications of the two groups were compared.Results The levels of IL-6 and IL-10 increased at the end of operation,30 mins and 6 hours after operation(P<0.05).In group A,the level of IL-6 after operation was lower than that 30 mins after operation(P<0.05).The level of IL-10 after operation was lower than that 30 mins after operation(P<0.05).The forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1))and FEV_(1)/FVC of the two groups one day before operation were higher than those of 6,12,24 and 48 hours after operation(P<0.05).At 12,24 and 48 hours after operation,the indexes of FVC%and FEV_(1)%in group A were lower than those in group B(P<0.05).Conclusion Patients with lung cancer undergoing thoracotomy after thoracic paravertebral block or thoracic epidural block can have varying degrees of inflammatory reaction,but thoracic paravertebral block has less damage to lung function,and the incidence of postoperative complications is low,which is conducive to the prognosis.

关 键 词：肺癌 胸段硬膜外阻滞 胸椎旁阻滞 开胸手术 肺功能 炎症反应 

分 类 号：R614[医药卫生—麻醉学]