腔镜直视下椎旁神经阻滞对全身麻醉胸腔镜下肺叶切除病人术后疼痛、应激反应及T淋巴细胞亚群的影响  

Effects of paravertebral nerve block under thoracoscopic direct vision on postoperative pain,stress response and T lymphocyte subsets in patients undergoing thoracoscopic lobectomy under general anesthesia

作　　者：高铁梅 佘汗涛 吴冰清 GAO Tiemei;SHE Hantao;WU Bingqing(Department of Anesthesiology,Nanjing Pukou People’s Hospital,Nanjing 211800,China)

机构地区：[1]南京市浦口人民医院麻醉科,211800

出　　处：《临床外科杂志》2025年第3期280-283,共4页Journal of Clinical Surgery

摘　　要：目的探讨腔镜直视下椎旁神经阻滞(PVNB)对全身麻醉胸腔镜下肺叶切除术病人术后疼痛、应激反应及T淋巴细胞亚群的影响。方法2021年1月~2023年8月择期行胸腔镜下肺叶切除术的病人104例,采用随机数字表法分成对照组和观察组,每组52例。对照组予以全身麻醉,观察组基于对照组予以PVNB,两组术后均使用静脉自控镇痛(PCIA)。记录两组术后1小时(T_(1))、术后6小时(T_(2))、术后12小时(T_(3))、术后24小时(T_(4))及术后48小时(T_(5))的视觉模拟疼痛(VAS)评分变化;比较两组PCIA药物使用状况、术后应激反应、T淋巴细胞亚群变化及不良反应发生率。结果T_(1)~T_(5)时刻两组VAS评分呈现先升后降的趋势变化,且T_(1)~T_(4)时刻观察组VAS评分均低于对照组,两组比较差异有统计学意义(P<0.05)。观察组和对照组PCIA首次按压时间分别为(11.18±3.29)小时和(9.61±2.48)小时,PCIA按压次数分别为(4.63±1.51)次、(7.22±1.86)次,舒芬太尼输注用量分别为(46.29±6.24)ml、(55.41±7.88)ml,两组比较差异有统计学意义(P<0.05)。术后24小时,观察组皮质醇、去甲肾上腺素、血糖分别为(252.27±19.75)ng/ml、(346.63±25.06)ng/ml和(5.48±0.72)mmol/L,对照组分别为(275.78±21.46)ng/ml、(381.71±23.71)ng/ml和(6.03±0.64)mmol/L,观察组上述指标均低于对照组,两组比较差异有统计学意义(P<0.05)。术后24小时,观察组CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞计数、CD4^(+)/CD8^(+)T淋巴细胞计数分别为(0.57±0.05)×10^(9)/L、(0.39±0.04)×10^(9)/L、(0.26±0.02)×10^(9)/L、(1.50±0.35),对照组上述指标分别为(0.55±0.05)×10^(9)/L、(0.36±0.03)×10^(9)/L、(0.29±0.04)×10^(9)/L、(1.24±0.31),两组比较差异有统计学意义(P<0.05)。两组不良反应发生率分别为1.92%、2.77%,两组比较差异无统计学意义(P>0.05)。结论对全身麻醉胸腔镜下肺叶切除术病人予以腔镜直视下PVNB有利于减轻病人术后疼痛感,减少机体应激反�Objective To investigate the effects of paravertebral nerve block(PVNB)under thoracoscopic direct vision on postoperative pain,stress response and T lymphocyte subsets in patients undergoing thoracoscopic lobectomy under general anesthesia.Methods A total of 104 patients who were scheduled to undergo thoracoscopic lobectomy in the hospital from January 2021 to August 2023 were enrolled in this study.They were divided into the control group(52 cases)and the observation group(52 cases)using the random number table.The control group was given general anesthesia,and the observation group was given PVNB on the basis of general anesthesia.Both groups received patient-controlled intravenous analgesia(PCIA)after surgery.Visual analogue pain(VAS)scores were recorded 1 hour(T_(1)),6 hours(T_(2)),12 hours(T_(3)),24 hours(T_(4))and 48 hours(T_(5))after surgery in both groups.The drug use for PCIA,postoperative stress response,changes in T lymphocyte subsets,and incidence rates of adverse reactions in the two groups were analyzed.Results From T_(1)to T_(5),VAS scores of the two groups increased firstly and then decreased.From T_(1)to T_(4),VAS scores of the observation group were lower than those of the control group(P<0.05).The first pressing time of PCIA in the observation group[(11.18±3.29)h]was longer than that in the control group[(9.61±2.48)h].The pressing times of PCIA and dosage of sufentanil[(4.63±1.51)times and(46.29±6.24)ml]were lower than those in the control group[(7.22±1.86)times and(55.41±7.88)ml](P<0.05).At 24 h after surgery,the levels of cortisol,norepinephrine and blood glucose in the observation group[(252.27±19.75)ng/ml,(346.63±25.06)ng/ml and(5.48±0.72)mmol/L]were lower than those in the control group[(275.78±21.46)ng/ml,(381.71±23.71)ng/ml and(6.03±0.64)mmol/L](P<0.05).The levels of CD3^(+),CD4^(+),CD8^(+)T lymphocyte count and CD4^(+)/CD8^(+)T lymphocyte count in the observation group[(0.57±0.05)×10^(9)/L,(0.39±0.04)×10^(9)/L,(0.26±0.02)×10^(9)/L and(1.50±0.35)]were higher than those

关 键 词：胸腔镜 椎旁神经阻滞 全身麻醉 肺叶切除 应激反应 T淋巴细胞亚群 

分 类 号：R61[医药卫生—外科学]