胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛效果及血生化指标的影响

Effects of Thoracic Paravertebral Nerve Block Combined with General Anesthesia on Analgesia and Blood Biochemical Parameters in Patients Undergoing Thoracoscopic Radical Resection of Lung Cancer

目的:探讨胸腔镜肺癌根治术患者应用胸椎旁神经阻滞复合全身麻醉后,对其镇痛效果、T淋巴细胞亚群以及血清肿瘤标志物的影响。方法:选取青海红十字医院于2015年9月~2018年10月期间接收的131例行胸腔镜肺癌根治术患者。采用随机数字表法将患者分为对照组(n=65)和研究组(n=66),对照组给予全身麻醉,研究组在对照组基础上复合胸椎旁神经阻滞,比较两组患者镇痛效果、自控静脉镇痛(PCIA)自控按钮启动次数、背景输注总量、T淋巴细胞亚群、血清肿瘤标志物以及不良反应。结果:研究组术后2h、12h、24h、48h安静时以及咳嗽时视觉疼痛模拟评分(VAS)均低于对照组(P<0.05);研究组术后24h、术后48h PCIA自控按钮启动次数、背景输注总量均低于对照组(P<0.05);研究组术后24h、术后48h、术后72h CD3^+、CD4^+、CD4^+/CD8^+均高于对照组(P<0.05);研究组术后24h癌胚抗原(CEA)、糖抗原199(CA199)、糖抗原125(CA125)水平均低于术前,且低于对照组(P<0.05);研究组不良反应总发生率低于对照组(P<0.05)。结论:胸椎旁神经阻滞复合全身麻醉应用于胸腔镜肺癌根治术患者,镇痛效果确切,可有效改善机体免疫功能,降低血清肿瘤标志物水平,安全可靠。

Objective: To investigate the effects of thoracic paravertebral nerve block combined with general anesthesia on analgesia, T lymphocyte subsets and serum tumor markers in patients undergoing thoracoscopic radical resection of lung cancer.Methods: 131 cases of thoracoscopic radical resection of lung cancer who were received in Qinghai Red Cross Hospital from September2015 to October 2018 were selected. The patients were divided into control group(n=65) and study group(n=66) by random number table method. The control group was given general anesthesia. The study group was combined with thoracic paravertebral nerve block on the basis of the control group. The analgesic effect, the number of start-up of self-controlled intravenous analgesia(PCIA) button, the total amount of background infusion, T lymphocyte subsets, serum tumor markers and adverse reactions were compared between the two groups. Results: Visual analogue pain score(VAS) at 2 h after operation, 12 h after operation, 24 h after operation and 48 h after operation in the study group when quiet and coughing were lower than those in the control group(P<0.05). The starting times of PCIA automatic button and the total amount of background infusion in the study group were lower than those in the control group at 24 h after operation and 48 h after operation(P<0.05). The CD3^+, CD4^+, CD4^+/CD8^+in the study group at 24 h after operation, 48 h after operation and 72 h after operation were higher than those in the control group(P<0.05). Carcinoembryonic antigen(CEA), carbohydrate antigen 199(CA199) and carbohydrate antigen 125(CA125) in the study group at 24 h after operation were lower than those before operation, and those in the study group were lower than those in the control group(P<0.05). The total incidence of adverse reactions in the study group was lower than that in the control group(P<0.05). Conclusion: Thoracic paravertebral nerve block combined with general anesthesia in thoracoscopic radical resection of lung cancer has a definite analgesic effect, which can effectively improve the immune function of the body, reduce the level of tumor clearance markers, and is safe and reliable.