椎旁阻滞术对肝胆手术患者术后疼痛评分和血清细胞因子水平的影响

Effects of paravertebral anaesthesia on postoperative algesia and serum tumor necrosis factor-α in patients underw ent hepatobiliary surgery

目的观察椎旁阻滞术对肝胆外科手术患者术后镇痛效果和炎症反应的影响。方法 2015年4月~2016年4月我院行肝胆外科手术治疗患者70例,采用随机数字表法将患者分为两组,每组35例。给予对照组患者全身麻醉,给予另一组患者椎旁阻滞联合全身麻醉。采用视觉模拟疼痛(VAS)评分,采用ELISA法检测血清肿瘤坏死因子α(TNF-α)和可溶性髓样细胞触发受体-1(s TREM-1)。结果在术后3 h和24 h时,椎旁阻滞联合全身麻醉组患者VAS评分为3.3±1.6和2.9±0.9,显著低于全身麻醉组(4.3±1.9和3.7±1.3,P<0.05);TNF-α分别为(139.7±73.8)pg/ml和(137.6±79.2)pg/ml,显著低于全身麻醉组[(204.2±68.0)pg/ml和(231.5±77.6)pg/ml,P<0.01];血清s TREM-1分别为(221.3±79.9)pg/ml和(216.9±90.4)pg/ml,显著性低于全身麻醉组[(279.8±125.6)pg/ml和(294.3±115.7)pg/ml,P<0.05]。结论椎旁阻滞联合全身麻醉可显著减轻肝胆手术患者术后疼痛,改善全身炎症反应指标。

Objective To observe the effect of paravertebral anaesthesia on the postoperative algesia and inflammatory response in patients after hepatobiliary surgery. Methods There were 70 patients who underwent hepatobiliary surgery in our hospital between April 2015 and April 2016,and they were randomly divided into study and control group with 35 cases in each. Patients in the control group received general anesthesia,while the patients in the study group were given paravertebral blockade at the base of general anesthesia. Visual analogue scales （VAS） were recorded,and serum tumor necrosis factor-α （TNF-α） and soluble triggering receptor expressed on myeloid cells-1 （sTREM-1） were detected by ELISA. Result 3 h and 24 h after surgery,VAS scores in the study group were 3.3±1.6 and 2.9±0.9,much lower than those in the control group （4.3±1.9 and 3.7±1.3,respectively,P〈0.O5）;Serum TNF-o~ levels in the study group were （139.7±73.8） pg/mt and （137.6±79.2） pg/ml,significantly lower than those in the control group [（204.2±68.0） pg/ml and （231.5±77.6） pg/ml,P〈0.01]; Serum levels of sTREM-1 in the study group were （221.3±79.9） pg/ml and （216.9±90.34） pg/ml,much lower than those in the control group I-（ 279.8± 125.6 ） pg/ml and （ 294.3± 115.7 ） pg/ml, respectively, P〈0.05 ]. Conclusion Paravertebral blockade at the base of general anesthesia may have a significantly analgesic effect and reduce the levels of serum inflammatory cytokines in patients after hepatobiliary surgery.