胸椎旁神经阻滞复合全身麻醉对乳腺癌手术炎性反应的影响

Effects of thoracic paravertebral block combined with general anesthesia on inflammatory reaction in breast cancer surgery

目的:探讨超声引导下胸椎旁神经阻滞复合全身麻醉对乳腺癌改良根治术患者炎性反应的影响。方法:连续48例接受乳腺癌改良根治术患者被随机分配到全凭静脉全身麻醉组(GA组)或胸椎旁神经阻滞(TPVB)复合全凭静脉麻醉组(PG组)。PG组在超声引导下于T4间隙行TPVB后,两组行全凭静脉麻醉;分别于麻醉前(T0)、手术开始30 min(T1)、术毕(T2)、术后8 h(T3)采集静脉血样,测定IL-6和IL-10的浓度,同时观察心率和平均动脉压的变化。结果:与T0时比较,两组患者在T2和T3时刻,IL-6和IL-10表达均明显升高(P<0.05);与GA组比较,PG组IL-6表达水平更低(P<0.05),而IL-10表达水平则更高(P<0.05)。结论:胸椎旁神经阻滞复合全身麻醉用于乳腺癌改良根治术患者时,可在一定程度上抑制炎性因子的释放。

Objective： To investigate inflammatory reaction in patients undergoing breast cancer surgery by ultrasound-guided thoracic paravertebral block（TPVB） combined with general anesthesia. Methods： After local ethics committee approval, 48 consecutive patients undergoing breast cancer surgery were randomized into the GA or the PG group. TPVB guided by ultrasound was app｜ied on PG group patients; blood samples were collected at preanesthetie（T0）, 30 rains after surgery started（T1）,when surgex~~ was completed （T2） and postoperative g h （T3）. Serum IL-6 and IL-10 were determined by ELISA while the changes of HR and MAP were observed. Results： Compared with TO, IL-6 and IL-10 expressions of patients in T2 and T3, were significantly increased （P〈0.05）; compared with the GA group, expression of 1L-6 levels of PG group were significantly lower （P 〈0.05）, while IL-10 expression levels were higher （P〈0.05）. Conclusion： TPVB can reduce inflammatory reaction in patients undergoing breast cancer surgery.