超声引导下单次竖脊肌平面阻滞对达芬奇辅助胸腔镜肺叶切除患者镇痛、炎性及免疫指标的影响

Effect of Ultrasound-guided Single Erector Spinalis Plane Block on Analgesia,Inflammatory and Immune Indexes of Pulmonary Lobectomy Under Da Vinci Operation

[目的]探究超声引导下单次竖脊肌平面阻滞(erector spinae plane block,ESPB)对机器人辅助胸腔镜肺叶切除的患者的镇痛效果和炎症因子及免疫功能的影响。[方法]选择拟行达芬奇辅助胸腔镜肺叶切除患者80例,随机数字表法分为观察组和对照组,每组40例。观察组在麻醉诱导前进行超声引导下的单次ESPB,对照组在麻醉诱导前行超声引导下的椎旁神经阻滞(thoracic paravertebral nerve block,TPVB)。两组患者术后均采用自控镇痛(patient controlled intravenous analgesia,PCIA)。采用视觉模拟法(VAS)评价患者静息和咳嗽时于拔管时(T_(1))、术后6 h(T_(2))、术后18 h(T_(3))、术后24 h(T_(4))和术后48 h(T_(5))的疼痛评分。统计患者术内24 h的下床病例数和患者术后48h内PCIA按压次数。采集患者术后24 h晨空腹静脉血,采用酶联免疫吸附试验(ELISA)检测患者炎症因子(1L-6.IL-8、CRP、TNF-a)和免疫功能指标(lgG、IgA、IgM)。[结果]观察组患者在T_(1)、T_(2)、T_(3)、T_(4)和T_(5)的静息和咳嗽状态的疼痛评分均低于对照组(P<0.05)。观察组患者术后24 h下床率高于对照组(82.5%vs 62.5%),两组比较差异有统计学意义(X^(2)=4.013,P<0.05).观察组术后48h内PCIA按压次数低于对照组[(3.37±0.87)次vs(3.92 ±0.76)次],两组比较差异有统计学意义(t=3.011,P<0.05)。观察组患者术后24 h炎症因子IL-6、IL-8、CRP.TNF-a水平低于对照组;术后24 h血清IgG、IgA、IgM免疫指标均高于对照组,差异均有差统计学意义(P<0.05)。[结论]机器人辅助胸腔镜肺叶切除患者经超声引导下单ESPB的镇痛效果优于TPVB,且术后炎症症状轻,说明ESPB相较于TPVB,患者的免疫功能更强。

[Objective]To investigate the analgesic effect of single erector spinae plane(ESP)block under ultrasound-guided Da Vinci robotic surgery for patients undergoing lower lobectomy and its effect on inflammatory factors and immune function.[Methods]A total of 80 patients who underwent Da Vinci robotic surgery for lower lobectomy was divided into an observation group and a control group,with 40 people in each group by the random number table method.The observation group underwent single ultrasound-guided ESP block before anesthesia induction,and the control group received ultrasound-guided paravertebral nerve block(TPVB)before anesthesia induction.The two groups used patient-controlled intravenous analgesia(PCIA)after operation.The visual simulation method(VAS)was used to evaluate pain score in the rest and cough at the time of extubation(T_(1)),6h after surgery(T_(2)),18h after surgery(T_(3)),24h after surgery(T_(4))and 48h after surgery(T_(5)).The number of patients getting out of bed cases within 24 hours and the number of PCIA compress-ions within 48 hours after operation were counted.The fasting venous blood of the patients was collected in the morning 24 hours after operation,and the inflammatory factors(1L-6.IL-8,CRP,TNF-a)and immune func-tion indicators(IgG.IgA.IgM)were detected by Enzyme-Linked Immunosorbent Assays(ELISA).[Results]Patients in the observation group had lower pain scores in the resting and cough during extubation(T_(1)),6h(T_(2)).18h(T_(3)),24h(T_(4))and 48h(T_(5))after surgery(P<0.05).The rate of getting out of bed cases in the observation group was 82.5%,which was higher than that in the control group 62.5%.The difference between the two groups was statistically significant(P<0.05).The number of PCIA compressions in the observation group was lower than that in the control group(P<0.05).The levels of inflammatory factors IL-6.IL-8.CRP,and TNF-a in the observation group were lower than those in the control group(P<0.05).The serum.IgG,lgA and IgM immune indexes of observation group were higher than those of control group aT_(2)4h after operation(P<0.05).[Conclusion]Robot-assisted thoracoscopic lobectomy patients with ultrasound-guided single ESPB have better analgesic effects than TPVB,and postoperative inflammation symptoms are mild,in-dicating that ESPB has stronger immune funetion compared with TPVB.