超声引导下星状神经节阻滞对乳腺癌根治术患者血清免疫炎症反应、PGE_(2)、SP、5-HT表达的影响及脑保护作用

The effect of ultrasound-guided stellate ganglion block on serum immune inflammatory response,PGE_(2),SP,5-HT expression and brain protection in patients undergoing radical mastectomy for breast cancer

目的探讨超声引导下星状神经节阻滞(SGB)在乳腺癌根治术患者中的应用效果,为临床麻醉方案的选择提供有效参考。方法选取2018年1月至2019年12月在湖南中医药高等专科学校附属第一医院行乳腺癌根治术的86例患者作为研究对象,按随机数字表法分为两组,各43例。在常规全身麻醉基础上,观察组于左侧第6颈椎水平在超声引导下行SGB干预,注入0.5%罗哌卡因7 ml,对照组于同一部位超声引导下注入等容量生理盐水干预。分别在麻醉诱导前(T_(1))、插管前(T_(2))、插管后即刻(T_(3))、切皮时(T_(4))、拔管时(T_(5))测定两组患者血流动力学、血清炎症因子、细胞免疫状态、前列腺素E_(2)(PGE_(2))、P物质(SP)、5-羟色胺(5-HT)表达脑氧代谢指标及手术前后认知功能评分(MMSE)。结果(1)血流动力学:两组T_(1)、T_(5)时刻HR、MAP相比,差异无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP低于对照组(P<0.05)。(2)炎症及免疫状态:两组T_(1)、T_(5)时刻IL-2、IL-18、TNF-α、CD3^(+)、CD4^(+)、CD8^(+)相比,差异无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻IL-2、IL-18、TNF-α、CD8^(+)低于对照组,CD3^(+)、CD4^(+)高于对照组(P<0.05)。(3)疼痛介质及脑氧代谢指标:两组T_(1)、T_(5)时刻PGE_(2)、SP、5-HT表达及SjvO_(2)、Da-jvO_(2)、CEO_(2)相比,差异无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻PGE_(2)、SP、5-HT表达及DajvO_(2)、CEO_(2)低于对照组,SjvO_(2)高于对照组(P<0.05)。(4)认知功能:术前1 d、术后5 d两组MMSE评分比较差异无统计学意义(P>0.05),术后13d,观察组MMSE评分高于对照组(P<0.05)。结论超声引导下SGB在乳腺癌根治术患者中的应用效果良好,可降低患者术中血流动力学波动,减轻术中机体炎症应激及免疫抑制作用,减少疼痛介质释放,同时改善脑氧代谢,促进术后认知功能恢复。

Objective To investigate the effect of ultrasound-guided stellate ganglion block(SCB)in patients undergoing radical mastectony,and to provide an effctive reference for the selection of clinical anesthesia.Methods A total of 86 patients undergoing radical mastectomy for breast cancer in the First Affiliated Hospital of Hunan Traditional Chinese Medicine College from January 2018 to December 2019 were selected as the research objects and randomly divided into two groups,with 43 cases in each group.On the basis of conventional general anesthesia,the observation group was treated with ultrasound-guided SGB intervention at the level of the sixth cervical vertebra on the left,and 0.5%ropivacaine was injected with 7 ml.The control group was treated with ultrasound-guided injection of equal volume normal saline at the same site.The hemodynamics and serum inflammatory factors,cellular immunity,prostaglandin E_(2)(PGE_(2)),substance P(SP),serotonin(5-HT)expression,cerebral oxygen metabolism indexes before an-esthesia induction(T_(1)),before intubation(T_(2)),immediately after intubation(T_(3)),during skin incision(T_(4))and extubation(T_(5)),and cognitive function score before and after surgery of the two groups were measured respectively.Results(1)Hemodynamics:the heart rate(HR)and mean arterial pressure(MAP)of the observation group at T_(2),T_(3),T_(4),were lower than those of the control group(P<0.05),and there was no significant difference between the two groups at T_(1),T_(5),(P>0.05).(2)Inflammation and immune status:there was no significant difference in interleukin(IL)-2,IL-18,tumor necrosis factor-ou(TNF-α),CD3^(+),CD4^(+) and CD8^(+) between the two groups at T_(1),T_(5),(P>0.05);the IL-2,IL-18,TNF-α and CD8^(+) at T_(2),T_(3)and T_(4) in the observation group were lower than those in the control group,while the CD3^(+) and CD4^(+) were higher than that in the control group(P<0.05).(3)Pain mediators and cerebral oxygen metabolism indexes:there was no significant difference in the levels of PGEq,SP,5-HT,SjvO_(2),Da-jvO_(2) and CEO_(2) between the two groups at T and T,(P>0.05);The levels of PGE_(2),SP,5-HT,Da-jvO_(2) and CEO_(2) in the observation group at T_(2),T_(3),and T_(4),were lower than those in the control!group,and the SjvO_(2) was higher than those in the control group(P<0.05).(4)Cognitive function:there was no significant difference in Mimi Mental State Examination(MMSE)scores between the two groups at I day before and 5 days after operation(P>0.05).At 1 and 3 days after operation,the MMSE score of the observation group was higher than that of the control group(P<0.05).Conclusions Ultrasound-guided SGB has a good application effect in patients undergoing radical mastectomy and can reduce the fluctuation of intraoperative hemodynamics.intraoperative inflammatory stress and immunosuppressive effects of the body,reduce the release of pain mediators,and at the same time improve cerebral oxygen metabolism,and promote postoperative cognitive function recovery..