星状神经节阻滞联合芬太尼对妇科恶性肿瘤患者术后镇痛及免疫应激反应的影响

Postoperative analgesia of stellate ganglion block combined with fentanyl infusion and its effect on immune stress in patients with gynecological malignant tumors

目的观察超声引导下星状神经节阻滞联合芬太尼对妇科恶性肿瘤患者术后镇痛及免疫应激反应的影响。方法选取2018年6月至2019年12月在三六三医院行手术治疗的妇科恶性肿瘤患者60例,其中使用芬太尼术后静脉镇痛20例(F组),使用羟考酮术后静脉镇痛20例(O组),使用星状神经节阻滞联合芬太尼术后静脉镇痛20例(SGB组)。3组患者麻醉诱导及麻醉维持方案相同,但采用不同的术后镇痛方案:F组、O组患者术后镇痛泵按照芬太尼15μg/kg或羟考酮1.5 mg/kg,配入0.9%氯化钠注射液中,总计100 ml,背景输注剂量为2 ml/h,患者自控镇痛(PCA)设定为1 ml/15 min,如果镇痛泵药物不足用至48 h,可重复配置。SGB组则在芬太尼术后静脉镇痛的基础上,在气管插管前给予超声引导下星状神经节阻滞。记录患者麻醉诱导前(T0)、拔除气管导管即刻(T1)、术后镇痛3 h(T2)、术后镇痛6 h(T3)、术后镇痛12 h(T4)、术后镇痛24 h(T5)、术后镇痛48 h(T6)各时点的疼痛评分(VAS评分)及不良反应发生情况;采集各时点的血液标本测定TNF-α和IL-6水平。结果3组患者术后各时点VAS评分比较差异均无统计学意义(均P>0.05)。术后各时点F组与O组患者血清TNF-α、IL-6水平均较术前升高(均P<0.05),但O组患者均低于F组(均P<0.05);SGB组患者血清TNF-α、IL-6水平除T1较T0增高外,其余时点与T0比较均无统计学差异(均P>0.05)。3组患者术后恶心、呕吐、呼吸抑制、头晕、皮肤瘙痒发生率比较差异均无统计学意义(均P>0.05)。结论星状神经节阻滞联合芬太尼对妇科恶性肿瘤患者术后镇痛效果好,可调控免疫应激反应,对免疫功能影响较小,安全可行。

Objective To observe the postoperative analgesia of ultrasound-guided stellate ganglion block combined with fentanyl infusion and its effect on immune stress in patients with gynecological malignant tumors.Methods Sixty patients with gynecological malignant tumors underwent surgical treatment in the 363 hospital during June 2018 to December 2019,among whom 20 cases received intravenous infusion of fentanyl(group F),20 cases received oxycodone group(group O),and another 20 cases received stellate ganglion block combined with fentanyl infusion for postoperative intravenous analgesia(SGB group),respectively.The anesthesia induction and intraoperative anesthesia maintenance programs were the same in three groups.In group F and group O,fentanyl and the oxycodone were diluted with 100 ml normal saline and given at 15μg/kg and 1.5 mg/kg,respectively.The background infusion dose was 2 ml/h,and the dose of patient controlled analgesia(PCA)was set at 1 ml/15 min.In the SGB group,on the basis of fentanyl analgesia,the ultrasound-guided stellate ganglion block was performed before endotracheal intubation.The VAS pain score,the number of PCA compressions,the amount of opioid used and the adverse reactions(nausea,vomiting,headache,dizziness,etc.)were recorded before anesthesia induction(T0),at tracheal extubation(T1),and 3 h(T2),6 h(T3),12 h(T4),24 h(T5),48 h(T6)of postoperative analgesia.Blood samples were collected at each time point to determine IL-6 and TNF-α levels.Results The Ramsey scores at T3,T4 in group O and SGB group were significantly lower than those in group F(P<0.05).However,there was no significant difference in Ramsey scores at T2,T5 and T6 among the three groups.The serum IL-6 and TNF-αlevels in group F and group O were significantly higher than those before anesthesia(P<0.05).However,the serum IL-6 and TNF-αlevels of group O was significantly lower than those of group F.In the SGB group,the serum IL-6 and TNF-α levels at T1 was significantly increased compared with that before anesthesia,while there were no significant differences at other time points compared with those before anesthesia(P>0.05).In addition,there were no significant differences in incidence of postoperative nausea,vomiting,respiratory depression,dizziness and skin pruritus among the three groups(P>0.05).Conclusion Stellate ganglion block combined with fentanyl infusion has a good postoperative analgesic effect on patients with gynecological malignant tumor,which can regulate immune stress and has a little impact on immune function.It is safe and feasible.