不同模式神经阻滞复合PCIA对非小细胞肺癌手术患者术后疼痛、免疫指标的影响

Effects of different nerve block modes combined with patient controlled intravenous analgesia on postoperative pain and immune indexes in patients with non-small cell lung cancer

目的分析不同模式神经阻滞复合静脉自控镇痛(PCIA)对非小细胞肺癌(NSCLC)手术患者术后疼痛、免疫指标的影响。方法选取2019年3月至2021年2月于空军军医大学唐都医院治疗的95例NSCLC患者为研究对象,按随机数表法分为A组(n=32)、B组(n=32)和C组(n=31),A组行肋间神经阻滞,B组行胸内直视下椎旁神经阻滞,C组行超声引导下经皮椎旁神经阻滞。比较三组患者术后不同时点的疼痛程度、术前与术后免疫功能和应激水平。结果术后1 h、2 h、3 h、24 h、48 h,B组和C组患者的视觉模拟疼痛评分(VAS)评分明显低于A组,差异均有统计学意义(P<0.05),但B组和C组患者术后各时点的VAS评分比较差异均无统计学意义(P>0.05);术后48 h,三组患者的CD4^(+)、CD4^(+)/CD8^(+)和CD8^(+)与术前1 d比较,CD4^(+)、CD4^(+)/CD8^(+)均降低,而CD8^(+)升高,且B组和C组患者的CD4^(+)和CD4^(+)/CD8^(+)明显高于A组,CD8^(+)明显低于A组,差异均有统计学意义(P<0.05),但B组和C两组患者间比较差异均无统计学意义(P>0.05);术后48 h,三组患者的皮质醇(Cor)和前列腺素E2(PGE2)水平与术前比较,Cor和PGE2均升高,且B组和C组患者的Cor和PGE2水平明显低于A组,差异均有统计学意义(P<0.05),但B组和C组患者间比较,差异无统计学意义(P>0.05)。结论与肋间神经阻滞比较,NSCLC手术患者行胸内直视下椎旁神经阻滞或行超声引导下经皮椎旁神经阻滞术后镇痛效果更为显著,其不仅能有效缓解患者术后免疫功能损伤,还能降低机体应激反应。

Objective To analyze the effects of different nerve block modes combined with patient controlled intravenous analgesia(PCIA)on postoperative pain and immune indexes in patients with non-small cell lung cancer(NSCLC).Methods A total of 95 NSCLC patients treated in Tangdu Hospital,Air Force Military Medical University from March 2019 to February 2021 were selected as subjects.They were divided into group A(n=32),group B(n=32)and group C(n=31)according to random number table method.The patients in group A received intercostal nerve block,group B received thoracic paravertebral nerve block,and group C received ultrasound-guided percutaneous paravertebral nerve block.The pain degree,preoperative and postoperative immune function,and stress level of patients in three groups were compared at different points after surgery.Results Postoperative 1 h,2 h,3 h,24 h,48 h,the Visual Analogue Scale(VAS)score of group B and group C were significantly lower than that in group A,with statistical significance differences(P<0.05).However,there was no significant difference in VAS scores at each time point after operation between group B and group C(P>0.05).At 48 h after surgery,compared with 1 d before surgery,CD4^(+)and CD4^(+)/CD8^(+)in the three groups were decreased,while CD8^(+)was increased;CD4^(+)and CD4^(+)/CD8^(+)levels in group B and C were significantly higher than those group A,and CD8^(+)was significantly lower than that in group A,with statistically significant differences(P<0.05);but there were no statistically significant differences between group B and group C(P>0.05).At 48 h after surgery,the levels of cortisol(Cor)and prostaglandin E2(PGE2)among the three groups were increased compared with those before surgery;the levels of Cor and PGE2 in group B and group C were significantly lower than those in group A,with statistically significant differences(P<0.05);there was no significant difference between group B and group C(P>0.05).Conclusion Compared with that of intercostal nerve block,postoperative analgesia of thoracic paravertebral nerve block under direct vision or ultrasound-guided percutaneous paravertebral block in NSCLC patients is more significant,which can effectively relieve postoperative immune function injury of patients and reduce the body's stress response.