胸椎旁神经阻滞联合自控静脉镇痛对胸腔镜肺癌根治术后免疫功能及不良反应的影响

Effects of thoracic paravertebral block combined with patient-controlled intravenous analgesia on immune function and adverse reactions after thoracoscopic radical resection of lung cancer

目的:分析胸椎旁神经阻滞(TPVB)联合自控静脉镇痛(PCIA)对胸腔镜肺癌根治术后免疫功能及不良反应的影响。方法:根据自愿接受的镇痛方式将120例于胸腔镜行根治术的非小细胞肺癌(NSCLC)患者分为研究组和对照组,每组各60例。研究组患者采用术中TPVB联合术后PCIA进行镇痛;对照组患者仅采用术后PCIA进行镇痛。对两组患者术后48 h内PICA按压次数、术后6 h、12 h、24 h、48 h的静息状态及咳嗽状态下视觉模拟量表(VAS)评分、术前1 d及术后48 h时的外周血CD4~+T淋巴细胞比例、CD8~+T淋巴细胞比例、CD4~+/CD8~+T淋巴细胞比值、血清皮质醇(Cor)、前列腺素E2(PGE2)、术后镇痛不良反应发生率进行记录和对比。结果:在术后48 h内,研究组患者的PICA按压次数少于对照组(P<0.05)。在术后各时点,研究组患者静息及咳嗽状态下的VAS评分均低于对照组,组间效应、组内效应、组间组内交互效应均有统计学意义(P<0.05)。在术后48 h时,两组患者的外周血CD4~+T淋巴细胞比例、CD4~+/CD8~+ T淋巴细胞比值均较术前下降(P<0.05),而外周血CD8~+T淋巴细胞比例及血清Cor、PGE2水平却均较术前上升(P<0.05)。此外,研究组患者的外周血CD4~+T淋巴细胞比例、CD4~+/CD8~+ T淋巴细胞比值高于对照组,而外周血CD8~+T淋巴细胞比例及血清Cor、PGE2水平、术后镇痛不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论:相对单独采用PCIA,在胸腔镜NSCLC根治术中采用TPVB联合PCIA的方式能够在术后早期达到更好的镇痛效果,缓解术后免疫功能损害,降低应激水平,减少PCIA的使用频率,降低镇痛不良反应发生率。

Objective:To analyzed the effects of thoracic paravertebral block(TPVB)combined with patient-controlled intravenous analgesia(PCIA)on immune function and adverse reactions after thoracoscopic radical resection of lung cancer.Methods:120 patients with non small cell lung cancer(NSCLC)undergoing thoracoscopic radical surgery were divided into the study group(n=60)and the control group(n=60)according to the voluntary analgesia method.The patients in the study group were treated with TPVB combined with postoperative PCIA for analgesia,while the patients in the control group were only treated with postoperative PCIA.The times of PICA pressing in 48 h after operation,visual analogue scale(VAS)scores in resting state and cough state at 6 h,12 h,24 h and 48 h after operation,CD4+T lymphocyte percentage,CD8+T lymphocyte percentage,CD4+/CD8+T lymphocyte ratio in the peripheral blood,serum cortisol(COR),prostaglandin E2(PGE2)levels and the incidence of postoperative analgesia adverse reactions between the patients in the two groups were recorded and compared.Results:Within 48 h after operation,the times of PCIA pressing of the patients in the study group was significantly less than that in the control group(P<0.05).At each time after operation,the VAS scores of the patients in the study group at rest and cough were lower than those in the control group,and the difference in inter group,intra group and inter group interaction were statistically significant(P<0.05).At 48 h after operation,the CD4+T lymphocyte percentage and CD4+/CD8+T lymphocyte ratio in the peripheral blood of the patients in the two groups were obviously decreased compared with those before operation,while the CD8+T lymphocyte percentage in the peripheral blood and the serum Cor,PGE2 levels were notably increased(P<0.05).Besides,the CD4+T lymphocyte percentage and CD4+/CD8+T lymphocyte ratio in the peripheral blood of the patients in the study group were significantly higher than those in control group,the CD8+T lymphocyte percentage in the peripheral blood,the serum Cor,PGE2 levels and total incidence of adverse reactions of postoperative analgesia were obviously lower than the control group,the difference was statistically significant(P<0.05).Conclusion:Compared with the application of PCIA,the application of TPVB combined with PCIA in thoracoscopic NSCLC radical surgerycan achieve better analgesic effects in the early postoperative period,relieve postoperative immune function damage,reduce the stress level,reduce the frequency of PCIA application,and reduce adverse reactions of analgesia.