胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛及免疫细胞功能的影响

Effect of thoracic paravertebral block combined with general anesthesia on postoperative analgesia and immune cell function in patients undergoing thoracoscopic lung resection surgery

目的探讨胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛及免疫细胞功能的影响。方法 87例择期行胸腔镜肺癌根治术患者随机分为全身麻醉组(n=43)和复合组(n=44),全身麻醉组患者采用单纯静吸复合全身麻醉下胸腔镜肺癌根治术,复合组患者则在全身麻醉组基础上,于麻醉诱导前行胸椎旁神经阻滞,两组患者均于术毕行自控静脉镇痛(PCIA)。记录两组患者术中瑞芬太尼用量,记录两组患者术后2、24和48 h时VAS评分情况,记录两组患者术后24和48 h时PCIA自控按钮启动次数及输注量,分别于麻醉诱导前或复合组神经阻滞前(T_0)、气管拔管即刻(T_1)、术后24 h(T_2)、48 h(T_3)和72 h(T_4)时,监测静脉血T淋巴细胞亚群CD3^+、CD4^+、CD8^+和NK细胞,并计算CD4^+/CD8^+值。结果复合组患者术后2和24 h时视觉模拟评分(VAS)与全身麻醉组比较,差异有统计学意义(P<0.05),复合组均低于全身麻醉组;复合组患者术后24和48 h时PCIA自控按钮启动次数和地佐辛输注量与全身麻醉组比较,差异有统计学意义(P<0.05),复合组均低于全身麻醉组;与T_0时比较,两组患者T_(1～4)时CD3^+、CD4^+、CD4^+/CD8^+比值和NK细胞水平均降低,差异有统计学意义(P<0.05);与全身麻醉组比较,复合组患者T_(2～4)时CD3^+、CD4^+、CD4^+/CD8^+比值和NK细胞水平均升高,差异有统计学意义(P<0.05)。结论胸椎旁神经阻滞复合全身麻醉可有效减轻胸腔镜肺癌根治术患者术后疼痛,减少术后阿片类药物用量,有助于改善患者术后免疫功能。

Objective To investigate the effect of thoracic paravertebral block combined with general anesthesia on postoperative analgesia and immune cell function in patients undergoing thoracoscopic lung resection surgery.Methods Eighty-seven patients undergoing thoracoscopic radical resection of lung cancer were divided into general anesthesia group(43 cases) and composite group(44 cases). The patients in the general anesthesia group accepted thoracoscopic lung resection surgery under simple static-general anesthesia; the patients in the composite group accepted the same treatment, but had thoracic nerve block before induction of anesthesia. All patients accepted patient-controlled intravenous analgesia(PCIA) after surgery. The dosages of Remifentanil during surgery, the VAS scores 2, 24 and 48 h after surgery, and the startup frequency of PCIA controlled button and infusion volume 24 and48 h after surgery were recorded in both groups. Respectively, before induction of anesthesia in the general anesthesia group or before nerve block in the composite group(T_0), at the time of tracheal extubation(T_1), 24(T_2), 48(T_3) and 72 h(T_4) after surgery, the T lymphocyte subsets CD3^+, CD4^+, CD8^+and NK cells in blood were detected,and the CD4^+/CD8^+ values were calculated. Results The VAS scores 2 and 24 h after surgery in the composite group were lower than those in the general anesthesia group, the differences were statistically significant(P < 0.05). The startup frequency of PCIA controlled button 24 and 48 h after surgery was lower and the dosages of Dezocine infusion in the composite group were smaller than those in the general anesthesia group, the differences were statistically significant(P < 0.05). Compared with T_0, the cell levels of CD3^+, CD4^+ and NK and CD4^+/CD8^+ ratios at T_1-T_4 were decreased in the two groups, the differences were statistically significant(P < 0.05). Compared with the general anesthesia group, the levels of CD3^+, CD4^+ and NK cells and CD4^+/CD8^+ ratio at T_1-T_4 were increased in the composite group, the differences were statistically significant(P < 0.05). Conclusions Thoracic paravertebral block combined with general anesthesia could effectively reduce the postoperative pain after thoracoscopic lung resection surgery, also reduce the postoperative opioid consumption, and help to improve the immune function of the patients.