超声下肋锁间隙连续臂丛阻滞对手外伤术患者疼痛、应激反应及免疫功能的影响

Effects of Continuous Brachial Plexus Block in Costoclavicular Space under Ultrasound on Pain,Stress Response and Immune Function in Patients Undergoing Hand Trauma

目的 探讨超声下肋锁间隙(costo-clavicular space,CCS)连续臂丛阻滞对手外伤术患者疼痛、应激反应及免疫功能的影响.方法 选取102例手外伤手术患者作为研究对象,按照随机数字表法分为对照组(超声下喙突入路连续臂丛神经阻滞)和观察组(超声下肋锁间隙入路连续臂丛阻滞),每组51例,对比两组患者神经深度、麻醉操作时间、术后第1次追加药物时间、VAS评分、Cor、NE、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平.结果 观察组患者的神经深度、麻醉操作时间及术后第1次追加药物时间均低于对照组(P<0.05).重复测量方差分析显示,两组患者VAS评分、Cor、NE、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平存在时点、组间及时点与组间交互作用(P<0.05);术后6、12、24、48 h,观察组患者的VAS评分低于对照组(P<0.05).术毕、术后24 h,观察组患者的Cor、NE、CD4^(+)/CD8^(+)水平低于对照组,而CD3^(+)、CD4^(+)、CD8^(+)水平更高(P<0.05).结论 超声下肋锁间隙连续臂丛阻滞在手外伤术中具有较为理想的镇痛效果,利于减轻术后生理疼痛和机体应激反应,并对免疫功能影响更小.

Objective To investigate the effects of continuous brachial plexus block in costoclavicular space under ultrasound on pain,stress response and immune function in patients undergoing hand trauma.Method A total of 102 patients with hand trauma surgery were selected as the research objects.According to the method of random number table,they were divided into the control group(receiving continuous brachial plexus block through ultrasonic proboscis burst approach) and the observation group(receiving continuous brachial plexus block through ultrasonic costoclavicular space approach),with 51 cases in each group.Nerve depth,anesthesia operation time,time of the first postoperative supplement,VAS score,Cor,NE,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+) were compared.Results The nerve depth,anesthesia operation time and the time of the first supplemental drug in the observation group were lower than those in the control group(P<0.05).Repeated measure analysis of variance showed that VAS score,Cor,NE,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+) existed time,intergroup and time-to-group interaction,and the differences were statistically significant(P<0.05).At 6 h,12 h,24 h and 48 h,the VAS score of the observation group was lower than that of the control group(P<0.05).After surgery and 24 h after surgery,Cor,NE and CD4^(+)/CD8^(+) in observation group were lower than those in control group,while CD3^(+),CD4^(+) and CD8^(+) were higher than those in control group(P<0.05).Conclusion Continuous brachial plexus block in the costoclavicular space under ultrasound has a relatively ideal analgesic effect in the operation of hand trauma,which is beneficial to reduce postoperative physiological pain and stress response,and has less effect on immune function.