超声引导下两种神经阻滞方式对胸腔镜下肺叶切除术患者炎症反应及免疫功能的影响  

Comparison of the effect of two nerve blocks methods under ultrasound guidance on inflammatory response and immune function in patients underwent thoracoscopic lobectomy

作　　者：张磊[1] 袁海军[1] 乐新会[1] 张宇帆[1] 王晨 赵栋[1] Lei Zhang;Hai-jun Yuan;Xin-hui Le;Yu-fan Zhang;Chen Wang;Dong Zhao(Department of Anesthesiology,Jinhua Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院麻醉科,浙江金华321000

出　　处：《中国内镜杂志》2022年第11期8-14,共7页China Journal of Endoscopy

基　　金：浙江省基础公益研究计划项目(No:LGF19H010008)。

摘　　要：目的比较超声引导下两种神经阻滞方式对胸腔镜下肺叶切除术患者炎症及免疫功能的影响,以期为该类患者的镇痛治疗提供参考。方法选择2020年1月-2021年7月该院114例行胸腔镜下肺叶切除术的患者,排除1例脱落病例,最终纳入113例患者,根据麻醉方式的不同,将其分为A组(n=57)和B组(n=56)。两组患者均在超声引导下进行阻滞,A组采用胸椎旁神经阻滞,B组采用竖脊肌平面阻滞。比较两组患者围手术期情况、炎症反应、应激反应和免疫反应相关指标,以及不良反应发生率。结果两组患者围手术期相关指标比较,差异均无统计学意义(P>0.05);两组患者术毕(T_(1))和术后24 h(T_(2))白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、皮质醇(Cor)、去甲肾上腺素(NE)及CD8+水平均较术前(T_(0))明显升高(P<0.05);两组患者CD3+、CD4+及CD4+/CD8+水平较T_(0)时点明显降低(P<0.05),且A组明显高于B组(P<0.05);A组不良反应发生率明显低于B组(P<0.05)。结论胸腔镜下肺叶切除术患者采用超声引导下胸椎旁神经阻滞,有助于减轻机体应激及炎症反应,对患者免疫功能的影响较轻,安全性较高。Objective To compare the effect of two nerve blocks methods under ultrasound guidance on inflammatory response and immune function of patients undergoing thoracoscopic lobectomy,in order to provide reference for analgesic treatment of patients.Methods The clinical data of 114 patients who underwent thoracoscopic lobectomy from Jan.2020 to Jul.2021 were selected,and 1 case was excluded from the study and 113 patients were finally included,which were divided into group A(n=57)and group B(n=56)depending on the type of anesthesia.The block under ultrasound guidance was performed in both groups,with thoracic paravertebral nerve block in group A and erector spinal plane block in group B.The perioperative conditions,the levels of related indexes of inflammatory,stress and immune reaction,and untoward effect were compared of both groups.Results The perioperative related indicators between the both groups were not apparently different(P>0.05);The interleukin-10(IL-10),IL-6,IL-1β,cortisol(Cor),norepinephrine(NE)and CD8^(+) levels of both groups at the end of surgery(T_(1))and 24 h after surgery(T_(2))were apparently increased compared with those before surgery(T_(0))(P<0.05),the CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) levels were apparently decreased compared with those at T_(0)(P<0.05),and the above indicators levels of group A were apparently higher in comparison with those of group B(P<0.05);The incidence of adverse reactions of group A was apparently lower in comparison with that of group B(P<0.05).Conclusion The application of thoracic paravertebral nerve block under ultrasound guidance in patients undergoing thoracoscopic lobectomy was helpful to reduce the stress and inflammatory response of body,and has less impact on immune function of patients,with good safety.

关 键 词：胸椎旁神经阻滞 竖脊肌平面阻滞 胸腔镜下肺叶切除术 炎症反应 免疫功能 

分 类 号：R614[医药卫生—麻醉学]