右美托咪定联合竖脊肌平面阻滞对胸椎椎体间植骨融合术患者术后炎症反应及细胞免疫功能的影响

Effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion

目的评价右美托咪定联合竖脊肌平面阻滞对胸椎椎体间植骨融合术患者术后炎症反应及细胞免疫功能的影响。方法择期行胸椎椎体间植骨融合术患者90例,年龄18~60岁,BMI 19~25 kg/m^2,ASA分级Ⅰ或Ⅱ级,性别不限,拟行手术椎体节段<6个。采用随机数字表法分为3组(n=30):全麻组(G组)、右美托咪定组(D组)、右美托咪定联合竖脊肌平面阻滞组(DE组)。D组和DE组于麻醉诱导前30 min经10 min输注右美托咪定0.5μg/kg,随后以0.5μg·kg^-1·h^-1维持至术毕前15 min。DE组于麻醉诱导前20 min时行超声引导下双侧竖脊肌平面阻滞,分别注入0.25%罗哌卡因30 ml。术后行PCA治疗。记录丙泊酚用量。术后48 h随访,记录患者PCA按压次数和舒芬太尼用量。记录患者苏醒时间、拔除气管导管时间和出血量。分别于麻醉诱导前即刻(T1)、手术30 min(T2)、术后1 h(T3)、1、3和5 d(T4-6)时采集桡动脉血样,采用流式细胞术检测血浆CD42^+、HLA-DR^+和CD14^+的水平,并计算CD42^+/CD14^+和HLA-DR^+/CD14^+。分别采用电阻抗法和乳胶增强散射比浊法检测WBC计数和血浆CRP浓度。结果与G组比较,D组PCA按压次数和舒芬太尼用量降低,CD42^+/CD14^+降低,T3-6时HLA-DR^+/CD14^+升高,DE组苏醒时间、拔除气管导管时间、PCA按压次数、舒芬太尼用量和丙泊酚用量降低,CD42^+/CD14^+降低,T3-6时HLA-DR^+/CD14^+升高,T2-6时血浆CRP浓度和WBC计数降低(P<0.05);与D组比较,DE组苏醒时间、拔除气管导管时间、PCA按压次数、舒芬太尼用量和丙泊酚用量降低,T5时CD42^+/CD14^+降低,T3-4时HLA-DR^+/CD14^+升高,T3-6时血浆CRP浓度和WBC计数降低(P<0.05)。结论右美托咪定联合竖脊肌平面阻滞可减轻胸椎椎体间植骨融合患者术后炎症反应,改善细胞免疫功能。

Objective To evaluate the effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion in patients.Methods Ninety American Society of Anesthesiologists physical statusⅠorⅡpatients of both sexes,aged 18-60 yr,with body mass index of 19-25 kg/m^2,scheduled for elective thoracic interbody fusion with the vertebral segments involved in the operation<6,were divided into 3 groups(n=30 each)using a random number table method:general anesthesia group(group G),dexmedetomidine group(group D)and dexmedetomidine plus erector spinae plane block group(group DE).In group D and group DE,dexmedetomidine was intravenously infused over 10 min at a loading dose of 0.5μg/kg starting from 30 min before anesthesia induction,followed by continuous infusion of 0.5μg·kg^-1·h^-1 until 15 min before the end of operation.In group DE,bilateral erector spinae blocks were performed under ultrasound guidance at 20 min before anesthesia induction,and 0.25%ropivacaine 30 ml was injected into each side.Patients received patient-controlled analgesia(PCA)after operation.The consumption of propofol was recorded.The patients were followed up for 48 h after operation,and the pressing times of PCA and consumption of sufentanil were recorded.The emergence time,extubation time and volume of blood loss were also recorded.Blood samples were collected from the radial artery immediately before induction(T1),at 30 min of operation(T2),and at 1 h and 1,3 and 5 days after operation(T3-6)for determination of plasma CD42^+,HLA-DR^+and CD14^+concentrations,white blood cell(WBC)count(by electrical impedance method)and plasma C-reactive protein(CRP)concentrations(by latex-enhanced scattering turbidimetry assay).CD42^+/CD14^+and HLA-DR^+/CD14^+ratios were calculated.Results Compared with group G,the pressing times of PCA and consumption of sufentanil were significantly decreased,CD42^+/CD14^+ratio was decreased,and HLA-DR^+/CD14^+ratio was increased at T3-6 in group D,and the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42^+/CD14^+ratio was decreased,HLA-DR^+/CD14^+ratio was increased at T3-6,and the plasma CRP concentrations and WBC count were decreased at T2-6 in group DE(P<0.05).Compared with group D,the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42^+/CD14^+ratio was decreased at T5,HLA-DR^+/CD14^+ratio was increased at T3,4,and the plasma CRP concentrations and WBC count were decreased at T3-6 in group DE(P<0.05).Conclusion Dexmedetomidine combined with erector spinae plane block can reduce inflammatory responses and improve cellular immune function after thoracic interbody fusion in patients.