胸腰筋膜平面阻滞对椎间孔镜手术患者炎性因子和应激反应的影响

Effect of thoracolumbar fascia plane block on inflammatory factors and stress response in patients undergoing transforaminal endoscopic spine system

目的观察胸腰筋膜平面(TLIP)阻滞对经皮椎间孔镜(TESSYS)手术患者炎性反应和应激反应的影响。方法选择择期行TESSYS手术的患者50例,年龄20~67岁,性别不限,采用随机数字表达法分为两组(n=25):局部浸润组(C组)和TLIP阻滞组(T组)。记录两组患者在术前即刻(T0)、手术开始30 min时的心率(HR)、平均动脉压(MAP);记录手术开始30 min的视觉模拟评分法(VAS)评分;记录术前即刻(T0)、术后即刻、术后12 h、术后24 h时的白细胞介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)等炎性因子的浓度和促肾上腺皮质激素(ACTH)、皮质醇(Cor)、血清胰岛素(Ins)等应激激素的浓度。组间比较采用独立样本t检验。结果与T组手术开始30 min时的HR[(93.32±6.32)次/分]、MAP[(110.12±7.22)mmHg(1 mmHg=0.133 kPa)]比较,C组在手术开始30 min时的HR[(100.80±8.55)次/分]加快、MAP[(116.56±7.44)mmHg]升高(t=3.519、3.104,P<0.01),差异有统计学意义。与T组[(2.80±0.76)分]比较,C组手术开始30 min时VAS评分[(4.28±0.79)分]升高(t=7.155,P<0.01),差异有统计学意义。与T组术后即刻、术后12 h、术后24 h的IL-6[(49.16±3.24)、(42.0±3.71)、(37.36±3.35)pg/ml]、IL-10[(39.00±3.58)、(33.44±3.15)、(31.44±2.40)pg/ml]、TNF-α[(18.68±1.60)、(15.52±1.08)、(13.56±1.04)pg/ml]、ACTH[(16.48±1.12)、(11.28±1.24)、(9.68±1.11)pg/ml]、Cor[(179.56±5.09)、(166.84±4.69)、(160.68±5.17)pg/ml]、Ins[(15.52±1.48)、(13.60±0.82)、(10.68±0.99)pg/ml]比较,C组在术后即刻、术后12 h、术后24 h的IL-6[(54.84±3.14)、(44.44±2.92)、(39.32±2.89)pg/ml]升高(t=6.294、2.586、2.216,P<0.01、0.05、0.05)、IL-10[(42.44±5.14)、(36.04±2.65)、(32.88±2.15)pg/ml]升高(t=2.745、3.156、2.236,P<0.01、0.05、0.05)、TNF-α[(25.72±1.95)、(18.56±1.47)、(14.72±1.21)pg/ml]升高(t=13.965、8.305、3.632,P<0.01)、ACTH[(23.44±1.36)、(12.24±1.27)、(9.68±1.11)pg/ml]升高(t=19.765、2.704、2.165,P<0.01、0.01、0.05)、Cor[(198.08±7.43)、(169.80±5.35)、(160.68±5.17)pg/ml]升高(t=10.284、2.080、2.049,P<0.01、0.05、0.05)、Ins[(16.80±1.08)、(14.16±0.94)、(11.24±0.88)pg/ml]升高(t=3.500、2.244、2.117,P<0.01、0.05、0.05),差异有统计学意义。结论TLIP阻滞可有效减轻TESSYS手术患者术中疼痛,减少血流动力学波动,减轻应激反应和炎性反应。

Objective To evaluate the effect of thoracolumbar fascia plane(TLIP)block on inflammatory factors and stress responses in patients undergoing transforaminal endoscopic spine system(TESSYS).Methods Fifty patients scheduled for TESSYS,aged 20-67 years,both sexes,were randomly divided into two groups(n=25 each):Local infiltration group(Group C)and TLIP block group(Group T).Heart rate(HR)and mean arterial pressure(MAP)in the two groups at T0(before the surgery),30 min after the beginning of the surgery were recorded.VAS scores were recorded at 30 min after the beginning of the surgery.The concentrations of inflammatory factors such as interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)and stress hormones such as adrenocorticotropic hormone(ACTH),cortisol hormone(Cor)and insulin(Ins)were recorded at T0(before the surgery),end of the surgery,12 h and 24 h after the surgery.Data was analyzed using the independent-samples t test for two group comparisons.Results The HR[(100.80±8.55)times/min]and MAP[(116.56±7.44)mmHg(1 mmHg=0.133 kPa)]at 30 min after the beginning of the surgery in the group C were higher than the HR[(93.32±6.32)times/min]and the MAP[(110.12±7.22)mmHg]in the group T(t=3.519,3.104,P<0.01).VAS score(4.28±0.79)at 30 min after the beginning of the surgery in the group C was higher than that(2.80±0.76)in the group T(t=7.155,P<0.01).The concentrations of IL-6[(54.84±3.14),(44.44±2.92),(39.32±2.89)pg/ml],IL-10[(42.44±5.14),(36.04±2.65),(32.88±2.15)pg/ml],TNF-α[(25.72±1.95),(18.56±1.47),(14.72±1.21)pg/ml],ACTH[(23.44±1.36),(12.24±1.27),(9.68±1.11)pg/ml],Cor[(198.08±7.43),(169.80±5.35),(160.68±5.17)pg/ml]and Ins[(16.80±1.08),(14.16±0.94),(11.24±0.88)pg/ml]at end of the surgery,12 h after the surgery in the group C were higher than the concentrations of IL-6[(49.16±3.24),(42.00±3.71),(37.36±3.35)pg/ml,t=6.294,2.586,2.216,P<0.01,0.05,0.05],IL-10[(39.00±3.58),(33.44±3.15),(31.44±2.40)pg/ml,t=2.745,3.156,2.236,P<0.01,0.05,0.05],TNF-α[(18.68±1.60),(15.52±1.08),(13.56±1.04)pg/ml,t=13.965,8.305,3.632,P<0.01],ACTH[(16.48±1.12),(11.28±1.24),(9.68±1.11)pg/ml,t=19.765,2.704,2.165,P<0.01,0.01,0.05],Cor[(179.56±5.09),(166.84±4.69),(160.68±5.17)pg/ml,t=10.284,2.080,2.049,P<0.01,0.05,0.05]and Ins[(15.52±1.48),(13.60±0.82),(10.68±0.99)pg/ml,t=3.500,2.244,2.117,P<0.01,0.05,0.05)]in the group T.Conclusion TLIP block could effectively reduce intraoperative pain in patients undergoing TESSYS,reduce hemodynamic fluctuations,reduce stress responses and inflammatory responses.