超声引导下连续收肌管阻滞联合关节周围浸润镇痛对全膝关节置换术患者术后免疫细胞的影响

Influence of ultrasound guided continuous adductor canal block combined with periarticular local infiltration on immune cells in patients undergoing total knee arthroplasty

目的比较超声引导下连续收肌管阻滞和超声引导下连续收肌管阻滞联合膝关节周围浸润镇痛对全膝关节置换术(TKA)围手术期免疫功能的影响。方法选择山西省长治市人民医院2018年6月至12月择期行单侧TKA的患者60例,随机数字表法分为阻滞组和联合组各30例。麻醉诱导前,2组患者均接受超声引导下的连续收肌管阻滞,联合组在关节周围注射0.2%罗哌卡因20 ml。于麻醉前(基础值)(T1)、手术结束后2 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)五个时间点抽取患者外周静脉血,用流式细胞仪检测T淋巴细胞亚群(CD3^+、CD4^+、CD4^+/CD8^+)及自然杀伤细胞。采用独立样本t检验比较不同时间点2组炎性因子水平的差异。结果与T1相比,2组患者CD3^+、CD4^+、CD4^+/CD8^+及自然杀伤细胞在T2、T3、T4、T5时间点有不同程度的下降,差异具有统计学意义(P<0.05);联合组CD3^+、CD4^+、CD4^+/CD8^+及自然杀伤细胞在T2、T3、T4时间点均高于阻滞组,差异具有统计学意义(P<0.05)。结论超声引导下连续收肌管阻滞联合膝关节周围浸润镇痛较单纯使用连续收肌管阻滞可以明显减轻对患者细胞免疫功能的抑制,促进患者康复。

Objective To compare the perioperative immune function after ultrasound guided continuous adductor canal block(CACB)alone and CACB combined with periarticular local infiltration analgesia(PLIA)in patients undergoing total knee arthroplasty(TKA).Methods Sixty patients in Changzhi City People′s Hospital from June to December 2018 undergoing TKA under general anesthesia were randomly divided into either a CACB alone group or CACB combined with PLIA group(PLIA group),with 30 cases in each group.Blood samples were assessed for the proportions of CD3^+,CD4^+,and NK cells as well as CD4^+/CD8^+ratio before surgery(T1)and 2 h(T2),12 h(T3),24 h(T4),and 48 h(T5)after surgery.Results Compared with T1,the levels of CD3^+,CD4^+,CD4^+/CD8^+ratio,and NK cells declined significantly in both groups at all time points after surgery(P<0.05).Compared with the CACB group,the levels of CD3^+,CD4^+,CD4^+/CD8^+,and NK cells at T2-T4 in the PLIA group were significantly higher(P<0.05).Conclusion CACB combined with PLIA can more significantly reduce postoperative knee joint pain,relieve passive movement pain,shorten passive movement time,and promote the patients'early movement and function recovery by reducing the suppression of immune function.