椎旁神经阻滞联合喉罩全身麻醉对单侧肺大泡切除术的免疫影响

Immunological effects of paravertebral nerve block combined with laryngeal mask general anesthesia on unilateral bullous resection

目的:探索胸椎旁神经阻滞联合喉罩全身麻醉对胸腔镜下单侧肺大泡切除术的免疫功能影响。方法:选取60例择期行经胸腔镜单侧肺大泡切除术的患者,随机分为研究组(n=30)和对照组(n=30)。研究组采用胸椎旁神经阻滞联合喉罩全身麻醉法,对照组采用双腔管全身麻醉法,记录两组丙泊酚、瑞芬太尼用药量、麻醉复苏时间,术后按压止痛泵次数;记录术前(T_(0))、术毕(T_(1))、术后24 h(T_(2))、术后48 h(T_(3))的IL-6,IL-10,CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)。结果:研究组丙泊酚用量、瑞芬太尼用量、止痛泵按压次数比对照组减少,差异具有统计学意义(P<0.05)。研究组IL-6、IL-10在T_(1)、T_(2)时间点的测量值均较对照组减少,差异具有统计学意义(P<0.05)。两组患者T_(1)、T_(2)、T_(3)时间点的CD_(4)^(+)及CD_(4)^(+)/CD_(8)^(+)值均较术前降低,但研究组的术毕、术后24 h的CD_(4)^(+)值较对照组明显增加,差异有统计学意义(P<0.05)。研究组T_(1)、T_(2)、T_(3)时间点CD_(4)^(+)/CD_(8)^(+)较对照组明显增加,差异有统计学意义(P<0.05)。结论:胸椎旁神经阻滞联合喉罩全身麻醉对胸腔镜下单侧肺大泡切除患者免疫功能的抑制程度小于双腔管全身静脉麻醉。

Objective To investigate the effect of parathoracic nerve block combined with laryngeal mask airway general anesthesia on immune function in patients undergoing video-assisted thoracoscopic unilateral pulmonary bullectomy.Method Sixty patients undergoing VATS unilateral bullous resection were selected and randomly divided into study group(n=30)and control group(n=30).The study group received parathoracic nerve block combined with laryngeal mask airway general anesthesia,and the control group received DLTs general anesthesia.Record the dose of propofol and remifentanil,the time of recovery from anesthesia and the number of postoperative tender pumps.Record the levels of IL-6,IL-10,CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)before operation(T_(0)),the end of operation(T_(1)),24 h after operation(T_(2))and 48 h after operation.Results The dose of propofol,remifentanil and the number of pain pumps in the study group were less than those in the control group(P<0.05).The levels of IL-6 and IL-10 in the study group were significantly lower than those in the control group(P<0.05).The CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)values at the end of surgery,24 hours after surgery and 24~48 hours after surgery in both groups were lower than those before surgery,but the CD_(4)^(+)values at the end of surgery and 24 hours after surgery was significantly higher than the control group(P<0.05).The number of CD_(4)^(+)/CD_(8)^(+)in the study group was significantly higher than that in the control group(P<0.05).Conclusion Parathoracic nerve block combined with laryngeal mask airway general anesthesia has less immunosuppressive effect on patients undergoing thoracoscopy unilateral pulmonary bullous resection than DLTs general anesthesia.