竖脊肌平面阻滞对胸腔镜肺叶切除术患者阿片药物用量及T细胞亚群的影响

Effect of Erector Spinae Plane Block on the Opioid Dosage and T Cell Subsets in Patients Undergoing Thoracoscopic Lobectomy

目的观察胸腔镜肺叶切除术患者术前预先给予超声引导下竖脊肌平面阻滞(ESP)后,阿片药物用量和外周血T淋巴细胞亚群的变化。方法选取2017年9—12月在绵阳市中心医院行择期胸腔镜肺叶切除术患者40例为研究对象,按照随机数字表法分为对照组和竖脊肌平面阻滞组(ESP组),每组20例。对照组实施全凭静脉麻醉,ESP组预先行竖脊肌平面阻滞,再实施全凭静脉麻醉,术后给予患者吗啡行静脉自控镇痛(PCA)。观察术中两组患者舒芬太尼、瑞芬太尼及术后吗啡的用量;患者自控镇痛总次数和PCA有效次数,术后2、4、6、12、24和48h的疼痛强度(VAS评分)及不良反应;测定麻醉前、术毕及术后12、24和48h外周血T淋巴细胞亚群CD3+、CD4+、CD8+及皮质醇水平。结果与对照组相比,ESP组舒芬太尼、瑞芬太尼及吗啡用量均降低(P<0.05);术后12、24和48hPCA总次数和PCA有效次数降低(P<0.05);术后2、4、6、12、24和48hVAS评分降低(P<0.05);术后烦躁和恶心呕吐的患者减少,差异均有统计学意义(P<0.05);术后两组患者血浆皮质醇均明显升高,对照组术后12、24、48h血浆皮质醇浓度明显高于ESP组,差异有统计学意义(P<0.05)。与麻醉前相比,术毕,术后12、24和48h,两组患者CD3+、CD4+、CD4+/CD8+均明显下降(P<0.05);ESP组患者于术后24、48h CD3+、CD4+、CD4+/CD8+均明显高于对照组,差异有统计学意义(P<0.05)。结论胸腔镜肺叶切除术前预先给予ESP可明显减少术中及PCA期间阿片药物的使用量及其不良反应,减轻围手术期应激反应及其对T细胞亚群的影响,有利于患者康复。

Objective To observe the effect of ultrasound-guided erector spinae plane block(ESP)on the opioid dosage and T-lymphocyte subtypes of peripheral blood in patients undergoing video-assisted thoracoscopic lobectomy.Methods A total of40patients undergoing video-assisted thoracoscopic lobectomy from September to December of2017in Mianyang Central Hospital were selected as the subjects and divided randomly into the control group and ESP group,and each group consisted of20cases.The control group received the total intravenous anesthesia,while the ESP group received the ultrasound-guided ESP at first,total intravenous anesthesia then,and postoperative patient-controlled analgesia(PCA)with morphine at last.The consumption of sufentanil,remifentanil and morphine,the total number and effective number of PCA and the adverse reactions were observed,and the intensity of pain2,4,6,12,24and48hours after operation were measured by the VAS scoring respectively.The counts of CD3^+,CD4^+,CD4^+/CD8^+and the blood cortisol level were detected before anesthesia,after operation,12,24and48hours after operation respectively.Results Compared with the control group,the consumption of sufentanil,remifentanil and morphine was significantly reduced(P<0.05),the total number and effective number of PCA12,24and48hours after operation were significantly decreased(P<0.05),the VAS scores2,4,6,12,24and48hours after operation were significantly lowered(P<0.05),and the number of patients with postoperative irritability and nausea and vomiting were decreased significantly in the ESP group(P<0.05).The blood cortisol levels were increased markedly in both groups,and those12,24and48hours after operation were significantly higher in the control group than in the ESP group(P<0.05).The levels of CD3^+,CD4^+,CD4^+/CD8^+were significantly decreased after operation,12,24and48hours after operation compared before anesthesia(P<0.05),and they were significantly higher in the ESP group than in the control group(P<0.05).Conclusion The administration of ESP prior to thoracoscopic lobectomy can significantly reduce the opioid dosage and adverse reactions during operation and PCA and the perioperative stress response and its effect on T cell subsets,which is beneficial to the recovery of patients.