胸科手术行胸椎旁阻滞预处理对患者血浆炎性因子的影响

The effect of thoracic paravertebral block on serum inflammation factor in thoracic surgery

目的观察胸科手术前行胸椎旁阻滞预处理对患者的镇痛效果及其对血浆白介素(IL)、皮质醇(Cor)、肿瘤坏死因子(TNF)表达水平的影响。方法 40例ASAⅠ-Ⅱ级胸腔镜下行胸科手术患者,随机分全身麻醉复合胸椎旁神经阻滞预处理组(Ⅰ组20例)和全身麻醉组(Ⅱ组20例)。分别于手术后30min(T1)、24h(T2)、48h(T3)以及72h(T4)四个时间点对患者的视觉模拟评分(VAS)进行测定,计算恶心、呕吐的发生率,同时测患者血浆中4个时点IL-6、IL-10、TNF和Cor的水平。结果在T1、T3、T4时刻,Ⅰ组受试者血浆IL-6及IL-10表达水平均明显低于Ⅱ组,且两组间差异有统计学意义(P<0.05);在T1、T2时刻,Ⅱ组受试者血浆TNF表达水平明显高于Ⅰ组,且两组间差异有统计学意义(P<0.05);在T2、T3、T4时刻,Ⅰ组受试者血浆Cor表达水平明显低于低于Ⅱ组,且两组间差异有统计学意义(P<0.05)。两组受试者间的VAS评分以及恶心、呕吐等不良反应发生率不存在显著差异。结论胸椎旁神经阻滞可阻断伤害性刺激向中枢神经的传导,有效减少炎性因子的产生,从而降低机体的应激反应,但对患者围术期镇痛治疗和麻醉苏醒期反应无明显影响。

Objective To explore the effect of thoracic paravertebral block on the plasma levels of interleukin,tumor necrestosis factor,cortisol and visual analogue scale in thoracic surgery.Methods 40 cases of ASA I to II VATS lobectomy patients,randomly divided into general anesthesia combined with thoracic paravertebral nerve block preconditioning group（group I,20 cases）and general anesthesia group（group II,20 cases）.Measured on a visual analogue scale,Calculate the incidence of nausea,vomiting at 30 minates after operation（T1）,24 h（T2）,48 h（T3）,72 h（T4）.At the same time measured in the plasma of patients with 4 point IL-6,IL-10,TNF and Cor levels.Results At T1,T3,T4 point,the plasma levels of IL-6 and IL-10 of patients in group I were obviously low than group II,and the difference between the two groups was statistically significant（P〈0.05）.The plasma levels of TNF of group I patients at T1 and T2 point were low than group II,and the difference between the two groups was statistically significant（P〈0.05）.At T2,T3,T4 point,the plasma levels of Cor of patients in group I were obviously low than group II,and the difference between the two groups was statistically significant（P〈0.05）.The VAS score,and the incidence of adverse reaction such as snausea,and vomiting had no significant difference between two groups of patients.Conclusion Thoracic paravertebral nerve block can block nociceptive nerve conduction,Effectively reduce inflammatory factors,eventually reduce the stress reaction of the body.But it had no significant effect on perioperative analgesia and anesthesia recovery period reaction.