超声下腰方肌阻滞对肾癌切除围手术期细胞免疫功能的影响

Effectsofperioperativecellular immune function of ultrasound guided quadratus lumborum block in patients undergoing radical operation of kidney cancer

目的探讨在超声引导下的腰方肌平面阻滞(QLB)对腹腔镜下肾癌全肾切除术患者围术期细胞免疫功能的影响。方法腹腔镜下单侧肾癌根治术患者60例。年龄48~73岁,体质量46~78 kg,ASAⅠ~Ⅱ级,采用随机数字表法分为两组,腰方肌平面阻滞复合全麻组(Q组,n=30)和单纯全麻组(D组,n=30),全麻后行超声引导下的患侧腰方肌平面阻滞,注射30 mL 0.4%罗哌卡因(Q组)、30 mL生理盐水(D组),术后行PCIA镇痛。记录两组患者诱导前即刻(T0)、切皮后即刻(T1)、切皮后1 h(T2)、切皮后2 h(T3)的有创动脉血压、心率,记录手术中瑞芬太尼和舒芬太尼用量、手术后24 h(T5)和48 h(T6)镇痛泵自控按压次数,术后2 h(T4)、术后24 h(T5)、术后48 h(T6)静止状态及咳嗽时VAS评分,检测T0、T4、T5、T6时外周静脉血中干扰素γ(INF-γ)和白介素4(IL-4)水平,计算INF-γ/IL-4比值。结果 Q组较D组在切皮时有创动脉收缩压、舒张压和心率变化明显较小(P <0.05),术中瑞芬太尼、舒芬太尼用量减少(P <0.05),术后24 h、48 h镇痛泵按压次数较少(P <0.05);T4、T5静止及咳嗽时VAS评分减轻(P <0.05);T4、T5、T6时刻INF-γ水平和INF-γ/IL-4明显高于D组(P <0.05)。结论超声下腰方肌平面阻滞能减轻腹腔镜下肾癌全肾切除术患者围术期的免疫抑制。

Objective To investigate the effects of perioperative cellular immne function of ultrasound guided quadratus lumborum block(QLB) in patients undergoing radical operation of Kidney carcinoma. Methods According to the random number table,60 patients(aged 48 ~ 73 years,weighing 46 ~ 78 kg,ASA grade Ⅰ or Ⅱ,undergoing operation of Laparoscopic radical nephrectomy)were randomly divided into two groups:QLB group(Group Q,n = 30),general anesthesia group(Group D,n = 30),Group Q received QLB on the ipsilateral with30 mL 0.4% ropivacaine after induction,while group D received equal normal saline. The Invasive arterial blood pressure,heart rate were recorded before the induction of anesthesia(T0),the moment after the skin incision(T1),1 h after the start of surgery(T2),2 h after the start of surgery(T3). The consumption of analgesic drug during the surgery and the number of times the pain pump presses was recorded within the 24 h(T5)and 48 h(T6)after the surgery were recorded. Also,the VAS scores at 2 h after the end of the surgery(T4),24 h after the surgery(T5),the 48 h after the surgery(T6)were obtained. Venous blood samples were obtained at T0,T4,T5,T6,and the plasma IL-4,INF-γ were evaluated. Results Combined with group D,The invasive arterial blood pressure,heart rate were more smooth and steady at skin incision in group Q(P < 0.05). the consumption of analgesic drug during the surgery were reduced(P < 0.05),the times the pain pump presses was less within the 24 h and 48 h after the surgery(P < 0.05). the VAS scores at T4 and T5 in group S were significantly decreased when rest and cough(P < 0.05). The INF-γ level and INF-γ/IL-4 ratio of T4,T5 and T6 increased(P < 0.05).Conclusion Ultrasound guided QLB can alleviate perioperative immuno-suppression in patients undergoing radical resection of Kidney carcinoma.