不同浓度罗哌卡因前锯肌平面阻滞对肺癌胸腔镜手术患者术后疼痛及免疫应答的影响

Effects of ropivacaine serratus anterior plane block at different concentrations on post-operative pain and immune response in lung cancer patients undergoing thoracoscopic surgery

目的 探讨超声可视下不同浓度罗哌卡因前锯肌平面阻滞在肺癌胸腔镜手术中的应用及其对患者术后疼痛、免疫应答的影响。方法 将90例行胸腔镜手术的肺癌患者按照随机数字表法分为A、B、C三组,每组30例。均行超声引导下前锯肌平面阻滞,A组采用0.25%的盐酸罗哌卡因20 mL,B组采用0.375%的盐酸罗哌卡因20 mL,C组采用0.50%的盐酸罗哌卡因20 mL。记录三组罗哌卡因起效时间、镇痛持续时间及运动功能恢复时间,比较不同时间点疼痛(视觉模拟评分法)评分、免疫应答(CD3^(+)、CD4^(+)、CD8^(+))、认知功能(简易智能精神状态检查量表)评分及不良反应。结果 C组患者起效时间快于A组、B组,且B组快于A组(P<0.05);C组镇痛持续时间、运动功能恢复时间长于A组、B组,且B组长于A组(P<0.05);术后4 h、8 h、12 h、24 h时C组疼痛评分低于A组、B组,B组低于A组(P<0.05);术后1 h、24 h C组CD3^(+)、CD4^(+)高于A组、B组,且B组高于A组(P<0.05);术后1 d、3 d A组、B组简易智能精神状态检查量表评分低于C组,A组低于B组(P<0.05);B组不良反应发生率为6.67%,低于C组30.00%(P<0.05)。结论 超声引导下前锯肌平面阻滞中0.50%的罗哌卡因用于行胸腔手术的肺癌患者,可获取更好的镇痛效果,减轻对机体免疫应答和术后认知功能的影响,但0.25%、0.375%的罗哌卡因不良反应更少,故临床时应根据肺癌患者年龄、机体状况合理选择合适浓度的罗哌卡因进行前锯肌阻滞。

Objective To explore the effects of ultrasound-guided ropivacaine serratus anterior plane block(SAPB)at different concentrations on post-operative pain and immune response in lung cancer(LC)patients undergoing thoracoscopic surgery.Methods Ninety LC patients undergoing thoracoscopic surgery were divided into three group A,B and C according to random number table,30 cases in each group.All patients underwent ultrasound guided serratus anterior plane block(SAPB),group A received 20 mL of 0.25%ropivacaine hydrochloride,B did 20 mL of 0.375%ropivacaine hydrochloride,and C did 20 mL of 0.50%ropivacaine hydrochloride.Taking-effect time,durations of analgesia and motor function recovery in three groups were recorded,scores on the Visual Analogue Scale(VAS),immune responses(CD3^(+),CD4^(+)and CD8^(+)),scores on cognitive function of the Mini-mental State Examination(MMSE)and adverse reactions compared at different time points.Results Taking-effect time was quicker in group C than A and B,so was B than A(P<0.05);durations of analgesia and motor function recovery were longer in group C than A and B,so were B than A(P<0.05);scores on the VAS at hour 4,8,12 and 24 after operation were lower in group C than A and B,so were B than A(P<0.05);CD3^(+)and CD4^(+)levels at hour 1 and 24 after operation were higher in group C than A and B,so were B than A(P<0.05);scores on the MMSE scores were lower in group A and B than C on the 1st and 3rd day after operation,so were A than B(P<0.05);the incidences of adverse reactions were lower in group B than C(6.67%vs.30.00%,P<0.05).Conclusion Ultrasound-guided 0.50%ropivacaine SAPB for lung cancer patients undergoing thoracic surgery could achieve better analgesic effects and reduce the influences on immune responses and postoperative cognitive function.But,0.25%and 0.375%ropivacaine have fewer adverse reactions.Therefore,appropriate concentrations of ropivacaine for the SAPB should be selected according to the age and physical condition of lung cancer patients.