胸腔镜肺癌根治术后病人自控椎旁神经阻滞对细胞免疫功能的优化程度

Patient-controlled paravertebral block in optimizing cellular immune function after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope

目的 评价胸腔镜肺癌根治术后病人自控椎旁神经阻滞（PCPB）对细胞免疫功能的优化程度.方法 择期胸腔镜肺癌根治术病人41例,年龄50 ～ 64岁,BMI 20～25 kg/m2,ASA分级Ⅰ或Ⅱ级,TNM分期Ⅰ或Ⅱ期,性别不限,采用随机数字表法,将其分为2组：PCIA组（n=21）和PCPB组（n=20）,PCIA组药液配方：舒芬太尼2μg/kg,生理盐水稀释至100 ml,背景输注速率2 ml/h,锁定时间15 min,PCA剂量2 ml;PCPB组术毕于患侧T5椎旁注射0.2％罗哌卡因5 ml,随后行PCPB,药液配方：0.75％罗哌卡因67 ml,生理盐水稀释至250 ml,背景输注速率5 ml/h,锁定时间15 min,PCA剂量5 ml,维持VAS评分≤3分,镇痛至术后50 h.分别于麻醉诱导前即刻（基础状态）、术毕、术后1、3、5d时采集静脉血样,检测调节性T细胞、自然杀伤细胞和自然杀伤T细胞的水平,并检测血浆白细胞介素-10和转化生长因子-β浓度.结果 与PCIA组比较,PCPB组术后1、3d时调节性T细胞水平降低,自然杀伤细胞水平和自然杀伤T细胞水平升高,血浆白细胞介素-10及转化生长因子-β的浓度降低（P＜0.05或0.01）,术后细胞免疫功能低下率差异无统计学意义（p＞0.05）.结论 胸腔镜肺癌根治术后PCPB对细胞免疫功能的优化程度无临床意义.

Objective To evaluate the patient-controlled paravertebral block （PCPB） in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in patients.Methods Forty-one ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 50-64 yr,with body mass index of 20-25 kg/m2,of TNM staging Ⅰ or Ⅱ,undergoing radical resection of pulmonary carcinoma performed via video-assisted thoracoscope,were randomly divided into 2 groups using a random number table：PCIA group （n =21） and PCPB group （n =20）.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In PCPB group,the patients received paravertebral injection of 0.2% ropivocaine 5 ml at T5 level on the affected side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0.75% ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose,with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3,and analgesia lasted until 50 h after operation.Before induction of anesthesia （baseline）,at end of operation,and at 1,3 and 5 days after operation,peripheral venous blood samples were collected to determine the levels of regulatory T cells,natural killer cells and natural killer T cells （by flow cytometry） and plasma concentrations of interleukin-10 and transforming growth factor-β （by ELISA）.Results Compared with group PCIA,the level of regulatory T cells was significantly decreased,the levels of natural killer cells and natural killer T cells were increased,and the plasma concentrations of interleukin-10 and transforming growth factor-β were decreased at 1 and 3 days after operation,and no significant change was found in the rate of cellular immune function decline after operation in group PCPB.Conclusion PCPB provides no significant difference clinically in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in the patients.