胸内直视下椎旁神经阻滞对非小细胞肺癌手术患者心肌酶谱及免疫功能的影响  

Effect of intrathoracic direct vision paravertebral nerve block on myocardial enzyme spectrum and immune function in patients undergoing surgery for non-small cell lung cancer

作　　者：黄瑜 韩乐 强准 Huang Yu;Han Le;Qiang Zhun(Department of Anesthesiology,Shaanxi Cancer Hospital,Xi’an Shaanxi 710061,China;Department of Chest Outer Ward,Shaanxi Cancer Hospital,Xi’an Shaanxi 710061,China)

机构地区：[1]陕西省肿瘤医院麻醉科,陕西西安710061 [2]陕西省肿瘤医院胸外二病区,陕西西安710061

出　　处：《中国医刊》2025年第2期160-163,共4页Chinese Journal of Medicine

基　　金：陕西省自然科学基础研究计划项目(2019JM-538)。

摘　　要：目的分析胸内直视下椎旁神经阻滞对非小细胞肺癌(NSCLC)手术患者心肌酶谱及免疫功能的影响。方法选取2023年3月至2024年2月陕西省肿瘤医院收治的150例进行手术治疗的NSCLC患者为研究对象,采用随机数字表法分为对照组和观察组,每组75例。对照组给予经皮椎旁神经阻滞,观察组给予胸内直视下椎旁神经阻滞。比较分析两组患者术后1、2、3、24、48 h的疼痛程度[视觉模拟评分法(VAS)评分]以及手术前后的肺损伤评分、心肌酶谱指标[肌钙蛋白T(Tn T)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]水平、免疫功能(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))。比较分析两组患者围手术期不良反应发生情况。结果术后1、2、3、24 h,观察组患者的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。与术前比较,两组患者术后48 h的肺损伤评分、CD8^(+)均升高,但观察组低于对照组,差异均有统计学意义(P<0.05)。与麻醉诱导前比较,两组患者术后24、48 h的Tn T、CK、CK-MB、LDH水平升高,差异均有统计学意义(P<0.05)。术后24、48 h,观察组患者的Tn T、LDH水平均低于对照组,差异均有统计学意义(P<0.05),而两组患者的CK、CK-MB水平比较差异均无统计学意义(P>0.05)。与术前比较,两组患者术后48 h的CD4^(+)、CD4^(+)/CD8^(+)均降低,但观察组高于对照组,差异均有统计学意义(P<0.05)。观察组患者围手术期不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论胸内直视下椎旁神经阻滞可显著减轻NSCLC手术患者的疼痛程度、肺损伤和心肌损伤,改善患者的免疫功能,且安全性较好。Objective To analyze the effect of intrathoracic direct vision paravertebral nerve block on myocardial enzyme spectrum and immune function in patients undergoing surgery for non-small cell lung cancer(NSCLC).Method A total of 150 patients with NSCLC undergoing surgery admitted to Shaanxi Cancer Hospital from March 2023 to February 2024 were selected as the study objects,and they were divided into control group and observation group by random number table method,with 75 patients in each group.The control group was given percutaneous paravertebral nerve block,and the observation group was given intrathoracic direct vision paravertebral nerve block.Pain degree(VAS score)at 1,2,3,24,48 h after surgery and lung injury score,myocardial enzyme spectrum(TnT,CK,CK-MB,LDH),immune function(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before and after surgery in the two groups were compared.The incidence of perioperative adverse reactions was compared between the two groups.Result At 1,2,3 and 24 h after surgery,the VAS scores in observation group were lower than those in control group,with statistical significance(P<0.05).Compared with before surgery,the lung injury score and CD8^(+)in two groups were increased at 48 h after surgery,but the observation group was lower than the control group,with statistical significance(P<0.05).Compared with before anesthesia induction,the levels of TnT,CK,CK-MB and LDH in two groups were increased at 24 and 48 h after surgery,with statistical significance(P<0.05).At 24 and 48 h after surgery,the TnT,LDH levels in observation group were lower than those in control group,with statistical significance(P<0.05),while there were no statistical significances in CK and CK-MB levels between the two groups(P>0.05).Compared with before surgery,CD4^(+),CD4^(+)/CD8^(+)in two groups were decreased at 48 h after surgery,but the observation group were higher than the control group,with statistical significance(P<0.05).The total incidence of perioperative adverse reactions in observation group was lower than that in co

关 键 词：胸内直视下椎旁神经阻滞 非小细胞肺癌 心肌酶谱 免疫功能 

分 类 号：R614.4[医药卫生—麻醉学]