腰方肌阻滞对腹腔镜结肠癌根治术患者免疫球蛋白及补体3水平的影响

Effects of quadratus lumborum block on immunoglobulin and complement 3 levels in patients undergoing laparoscopic radical resection of colon cancer

目的探讨腰方肌阻滞对腹腔镜下结肠癌根治术患者免疫球蛋白(IgG、IgM、IgA)及补体3(C3)水平的影响,为临床工作提供参考。方法选择本院2019年1~9月拟择期行腹腔镜下结肠癌根治术患者40例,应用随机数字表法分为全麻复合腰方肌阻滞组(实验组)和全麻复合切口局部浸润组(对照组),每组20例。全麻诱导后实验组行超声引导下双侧腰方肌阻滞,每侧各注射0.375%罗哌卡因20 mL,对照组则切口部位行浸润阻滞,注射0.375%罗哌卡因40 mL。观察并记录两组患者的手术时间、失血量、术后每24小时布托啡诺输注总量及术后48 h内眩晕、呕吐次数,记录术后首次肛门排气时间。于麻醉前30 min(T0)、术后1 d(T1)、术后3 d(T2)和术后7 d(T3)清晨测定血清中IgG、IgM、IgA,C3水平。结果与对照组相比,实验组术后24 h布托啡诺输注总量以及术后48 h内眩晕、呕吐次数均明显少于对照组,差异均有统计学意义(P<0.05);与对照组相比,实验组IgG、IgM、C3在T1、T2时明显高于对照组,实验组IgA在T2时明显高于对照组,差异均有统计学意义(P<0.05);与T0比较,T1和T2实验组与对照组的IgG、IgM、IgA和C3均明显低于T0,差异均有统计学意义(P<0.05)。结论全麻复合双侧腰方肌阻滞对腹腔镜结肠癌根治术患者机体的体液免疫抑制影响较小。

Objective To investigate the effects of quadratus lumborum block on immunoglobulin(IgG,IgM and IgA)and complement 3(C3)levels in patients undergoing laparoscopic radical resection of colon cancer,and to provide a reference for clinical practice.Methods 40 patients undergoing elective laparoscopic radical resection of colon cancer from January to September 2019 were selected,and were divided into the group of general anesthesia combined with quadratus lumborum block(experimental group)and the group of general anesthesia combined with local incision infiltration(control group)by using random number table method,with 20 patients in each group.After induction of general anesthesia,the experimental group was treated with ultrasonically guided bilateral quadratus lumborum block,with an injection of 20 mL of 0.375%ropivacaine on each side;and the control group received infiltration block at the incision site,with an injection of 40 mL of 0.375%ropivacaine.The operation time,blood loss,total amount of butorphanol infusion every 24 h after surgery,and number of dizziness and vomiting within 48 h after surgery of the two groups of patients were observed and recorded,and the first postoperative anal exhaust time was recorded.Levels of IgG,IgM,IgA and C3 in serum were determined 30min before anaesthesia(T0),1 day after surgery(T1),3 days after surgery(T2),and 7 days after surgery(T3).Results Compared with the control group,the total amount of butorphanol infusion 24 hours after surgery and the number of dizziness and vomiting within 48 h after surgery in the experimental group were significantly lower than those in the control group,the difference was statistically significant(P<0.05);compared with the control group,IgG,IgM and C3 in the experimental group were significantly higher at T1 and T2 than those in the control group,while IgA in the experimental group was significantly higher at T2 than that in the control group,the difference was statistically significant(P<0.05);compared with T0,IgG,IgM,IgA and C3 in the experimental group and the control group were all significantly lower at T1 and T2 than at T0,the difference was statistically significant(P<0.05).Conclusion General anesthesia combined with bilateral quadratus lumborum block has little effect on humoral immunosuppression in patients undergoing laparoscopic radical resection of colon cancer.