竖脊肌平面阻滞对腹腔镜结直肠癌根治术患者细胞免疫功能的影响

Effect of erector spinae plane block on cellular immunity in patients undergoing laparoscopic resection of colorectal tumors

目的探讨竖脊肌平面阻滞(ESP)对腹腔镜结直肠癌根治术患者细胞免疫功能的影响。方法选择60例择期拟行腹腔镜结直肠癌根治术患者,采用随机数字表法分为3组:竖脊肌平面阻滞复合全凭静脉麻醉组(ESP组)、硬膜外阻滞复合全凭静脉麻醉组(CEP组)和腹横肌平面阻滞复合全凭静脉麻醉组(TAP组),每组20例。ESP组采用超声引导下双侧竖脊肌平面阻滞,CEP组采用硬膜外神经阻滞,TAP组采用超声引导下双侧腹横肌平面阻滞。于手术前1d清晨(T0)、手术结束离开麻醉复苏室前5min(T1)、术后24h(T2)、48h(T3)、72h(T4)、96h(T5)6个时点分别抽取静脉血5ml,应用流式细胞仪检测血液NK细胞数目、Th1/Th2比值,ELISA检测血清中干扰素(IFN)浓度;并观察患者T1～T3视觉模拟评分(VAS)。结果在T1时点,ESP组和CEP组VAS评分明显低于TAP组(P<0.05),ESP组与CEP组相比差异无统计学意义(P>0.05);在T2、T3时点,ESP组患者VAS评分明显低于CEP组和TAP组(P<0.05)。与T0时点比较,各组患者T_1～T_5时点NK细胞数目、Th1/Th2比值和IFN浓度均降低,ESP组与CEP组相比较,差异无统计学意义(P>0.05),但与ESP组和CEP组分别相比,TAP组明显下降(P<0.05)。结论竖脊肌平面阻滞复合全凭静脉麻醉与硬膜外麻醉阻滞复合全凭静脉麻醉同样对腹腔镜结直肠癌根治术患者细胞免疫功能影响较小。

Objective To investigate the effects of erector spinae plane block on cellular immun in patients undergoing laparoscopic resection of colorectal tumors. Methods Sixty patients scheduled to undergo laparoscopic resection of colorectal tumors were randomly assigned in three groups with 20 cases in each: patients in ESP group received ultrasound-guided erector spinae plane block combined with intravenous anesthesia, patients in CEP group received epidural block combined with intravenous anesthesia and patients in TAP group received ultrasound-guided transverse abdominis plane block combined with intravenous anesthesia. Anesthesia induction and maintenance medication were given in three groups. Blood samples were collected at 1 d before operation (T0), 5min before leaving postanesthesia care unit (T1), and 24 h (T2), 48 h (T3), 72 h (T4), 96 h (T5) after operation, respectively. Flow cytometry was used to detect the number of NK cells and the ratio of Th1/Th2. The concentration of IFN in serum was detected by ELISA. The visual analogue scores (VAS) at T1, T2 and T3 were observed. Results The VAS in ESP group and CEP group was significantly lower than that in TAP group at T1(P<0. 05);while there was no significant difference between CEP group and ESP group at T1(P >0. 05). The VAS in ESP group was significantly lower than that in CEP group and TAP group at T2 and T3(P<0. 05). Compared with the T0, the number of NK cells, the ratio of Th1/Th2 and the concentration of IFN decreased at T1 ~5 in all groups. Compared with EAP group, the number of NK cells, the ratio of Th1/Th2 and the concentration of IFN in TAP group were significantly lower(P<0. 05), while there was no significant difference between ESP group and CEP group (P >0. 05). Conclusion Erector spinae plane block combined with intravenous anesthesia and epidural anesthesia combined with intravenous anesthesia have little effect on cellular immune function of patients undergoing laparo scopic resection of colorectal tumors.