超声引导下竖脊肌平面阻滞对后路腰椎手术患者免疫功能的影响

Effect of ultrasound-guided erector spinae muscle block on immune function in patients undergoing posterior lumbar spine surgery

目的:探究超声引导下竖脊肌平面阻滞应用于后路腰椎手术患者中对免疫功能的影响。方法:选取2019年1月至2019年6月在本院治疗的60例因两节段腰椎间盘突出症而进行后路腰椎手术患者作为本次研究对象,以掷硬币分组法将其分为参照组(30例,在静—吸复合麻醉基础上给予自控静脉镇痛)和研究组(30例,在参照组基础上给予超声引导下竖脊肌平面阻滞),对比两组患者术前、术后即刻、术后4 h、术后12 h、术后24 h多个阶段患者血浆中CD4+%、CD8+%、γ干扰素等指标的水平,CD4+%、CD8+%均采用流式细胞仪测定,γ干扰素采用酶联免疫吸附试验测定,同时对比两组手术时间、术后不同时间段(术后4 h、术后12 h、术后24 h)疼痛情况。结果:麻醉前,两组患者CD4+%、CD8+%、γ干扰素水平比较差异均无统计学意义(P>0.05)。研究组术后即刻、术后4 h、术后12 h、术后24 h,CD4+%、CD8+%、γ干扰素水平明显优于参照组(P<0.05)。两组手术时间差异无统计学意义(P>0.05)。研究组术后不同时间段疼痛评分明显低于参照组(P<0.05)。两组舒芬太尼、丙泊酚用药量无统计学意义(P>0.05),研究组顺式阿曲库铵用量明显低于参照组(P>0.05)。结论:超声引导下竖脊肌平面阻滞应用于后路腰椎手术患者中的优势明显,术后可有效缓解患者疼痛程度,对免疫功能影响较小。

Objective:To explore the effect of ultrasound-guided erector spinae muscle block on immune function in patients undergoing posterior lumbar spine surgery.Methods:60 patients undergoing posterior lumbar spine surgery due to two-segment lumbar disc herniation treated from January 2019 to June 2019 in our hospital were selected as the object of this study.It is divided into a reference group(30 cases,given controlled intravenous analgesia on the basis of static-aspiration combined anesthesia)and a research group(30 cases,based on the reference group based on ultrasound-guided erector spinae plane block),compared the levels of CD4+%,CD8+%,interferon gamma and other indicators in the plasma of the two groups of patients before,immediately after surgery,4 hours after surgery,12 hours after surgery,and 24 hours after surgery,CD4+%,CD8+%were both.It was measured by flow cytometry,and interferon-gamma was measured by enzyme-linked immunosorbent assay.At the same time,the operation time and the postoperative pain at different time periods(4 hours after surgery,12 hours after surgery,and 24 hours after surgery)were compared between the two groups.Results:Before anesthesia,there was no significant difference in the levels of CD4+%,CD8+%,and interferon gamma between the two groups(P>0.05).Immediately after surgery,4 hours after surgery,12 hours after surgery,and 24 hours after surgery,the levels of CD4+%,CD8+%,and interferon gamma in the study group were significantly better than those in the reference group(P<0.05).The difference in operation time between the two groups was not statistically significant(P>0.05).The pain score of the study group at different time periods after operation was significantly lower than that of the reference group(P<0.05).The doses of sufentanil and propofol in the two groups were not statistically significant(P>0.05).The dosage of cis-atracurium in the study group was significantly lower than that in the reference group(P>0.05).Conclusion:The ultrasound-guided erector spinae plane block has obvious advantages in patients with posterior lumbar spine surgery.It can effectively relieve patients'pain after surgery,has little effect on immune function,and has certain clinical value.