腰方肌阻滞对经腹直肠癌根治术术后镇痛效果及T淋巴细胞亚群的影响

Effect of quadratus lumborum block on postoperative analgesia and T lymphocyte subsets in the patients receiving transabdominal radical resection of rectal cancer

目的探讨腰方肌阻滞对经腹直肠癌根治术术后镇痛效果及T淋巴细胞亚群的影响,为临床提供参考。方法选择本院2016年5月~2017月11月择期经腹直肠癌根治术患者30例,采用随机数字表法分为腰方肌阻滞组(实验组)和切口局部浸润阻滞组(对照组),每组15例。实验组患者全麻诱导后行超声引导下双侧前外侧路腰方肌阻滞,每侧注射0.375%罗哌卡因20 m L,对照组则全麻诱导后切口部位0.375%罗哌卡因40 m L进行局部浸润阻滞。观察并记录两组患者的手术时间、失血量、丙泊酚输注总量、有效镇痛时间、术后每12小时舒芬太尼输注量以及术后不同时间点(术后2、6、12、24、36、48 h)静息VAS评分。于麻醉前30 min(T0)、术后2 h(T1)、术后1 d(T2)和术后3 d(T3)抽取静脉血1 m L,采用流式细胞仪检测T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)。结果与对照组相比,实验组丙泊酚用量明显少于对照组(P<0.05);实验组有效镇痛时间明显长于对照组(P<0.01);实验组在术后0~12 h和12~24 h时间段内舒芬太尼用量明显少于对照组(P<0.05);实验组在术后6 h和12 h静息VAS评分明显低于对照组(P<0.05);实验组CD3+、CD4+、CD4+/CD8+在T2时明显高于对照组(P<0.05)。与T0比较,T1和T2时两组的CD3+、CD4+、CD4+/CD8+明显低于T0(P<0.05);T2时对照组CD8+明显低于T0(P<0.05)。结论双侧腰方肌阻滞可以明显改善经腹直肠癌根治术患者术后镇痛效果,减轻手术应激对T淋巴细胞的抑制。

Objective To investigate the effect of quadratus lumborum block on postoperative analgesia and T lymphocyte subsets in patients receiving transabdominal radical resection of rectal cancer, so as to provide clinical references.Methods From May 2016 to November 2017, 30 patients receiving selective radical resection of rectal cancer in our hospital were selected. The random number table was used to divide the patients into quadratus lumborum block group（experimental group） and incision partial infiltration block group（control group）, with 15 patients in each group. After induction of general anesthesia, the experimental group underwent ultrasound-guided bilateral anterior lateral quadratus lumborum block. Each side was injected with 0.375% ropivacaine of 20 m L. The control group was induced by general anesthesia and 0.375% ropivacaine of 40 m L was injected for local infiltration block. The surgery time, volume of blood loss, total infusion volume of propofol, effective analgesia time, the amount of sufentanil infusion every 12 hours after surgery and resting VAS scores at postoperative different time points（2, 6, 12, 24, 36, 48 hours postoperatively） were observed and recorded. Venous blood（1 m L） was drawn 30 minutes before anesthesia（T0）, 2 hours after surgery（T1）, 1 day after surgery（T2） and 3 days after surgery（T3）. T lymphocyte subsets were detected by flow cytometry（CD3＋, CD4＋,CD8＋, CD4＋/CD8＋）. Results Compared with the control group, the dosage of propofol in the experimental group was significantly less than that in the control group（P〈0.05）; the effective analgesia time in the experimental group was significantly longer than that in the control group（P〈0.01）; the amount of sufentanil in the experimental group was significantly less than that in the control group at 0-12 h and 12-24 h after surgery（P〈0.05）; the resting VAS scores in the experimental group at 6 h and 12 h after the surgery were significantly lower than those in the control group（P〈0.05）;the levels of CD3＋, CD4＋, CD4＋/CD8＋ in the experimental group were significantly higher than those in control group at T2（P〈0.05）. Compared with T0, CD3＋, CD4＋, CD4＋/CD8＋ at T1 and T2 in the two groups were significantly lower than those at T0（P〈0.05）; at T2, CD8＋ in the control group was significantly lower than that at T0（P〈0.05）. Conclusion Bilateral quadratus lumborum block can significantly improve postoperative analgesia effect in patients receiving radical resection of rectal cancer and reduce the inhibition of T lymphocytes by surgical stress.