竖脊肌平面阻滞对胸腔镜肺叶切除术患者术后早期恢复及细胞免疫功能的影响

Effects of Erector Spinae Plane Block on Early Postoperative Recovery and Cellular Immune Function in Patients Undergoing Thoracoscopic Lobectomy

目的观察全身麻醉联合超声引导下竖脊肌平面阻滞(ESPB)对胸腔镜下肺叶切除术患者术后早期恢复质量及NK细胞、CD4^(+)和CD8^(+)T细胞水平的影响。方法选择雅安市人民医院2021年8—12月行择期单侧胸腔镜肺叶切除术的90例肺癌患者为研究对象,采用随机数字表法将其分为对照组(行单纯全身麻醉)和试验组(行全身麻醉联合ESPB),每组45例。记录两组患者一般情况、手术时间、出血量及瑞芬太尼用量;记录两组患者在入手术室(T0)、切皮(T1)、手术开始后10 min(T2)和拔管时(T3)的心率和平均动脉压;采用恢复质量评分量表(QoR-40)评估两组患者术后24 h恢复质量;比较术前和术后24 h两组患者NK细胞及CD4^(+)、CD8^(+)T细胞水平。结果与对照组比较,试验组术中瑞芬太尼泵用量明显低于对照组(P<0.05);两组在T0、T1、T2、T3时心率和平均动脉压比较差异无统计学意义(P>0.05);术后24 h试验组身体舒适度、疼痛评分及NK细胞、CD4^(+)和CD8^(+)T细胞水平均明显高于对照组(P<0.05)。结论超声引导下ESPB可减少胸腔镜肺叶切除术患者术中阿片类药物用量,减轻术后疼痛,改善患者术后细胞免疫功能,促进患者术后早期恢复。

Objective To observe the effects of general anesthesia combined with ultrasound-guided erector spinae plane block(ESPB)on early postoperative recovery quality and levels of natural killer(NK)cells,cluster of differentiation 4-positive T-lymphocyte(CD4^(+)T)and cluster of differentiation 8-positive T-lymphocyte(CD8^(+)T)cells in patients undergoing thoracoscopic lobectomy.Methods A total of 90 lung cancer patients scheduled for unilateral thoracoscopic lobectomy at Ya'an People's Hospital from August 2021 to December 2021 were selected.They were randomly divided into two groups by random number table method:the control group(n=45,receiving general anesthesia only)and the experimental group(n=45,receiving general anesthesia combined with ESPB).The general conditions of the patients,the duration of surgery,the intraoperative amount of blood loss and dosage of remifentanil of the two groups were recorded.The heart rate and mean arterial pressure of the patients in both groups at the time of admission to the operating room(T0),skin incision(T1),10 min after the start of surgery(T2)and extubation(T3)were recorded.The 40-item Quality of Recovery Score(QoR-40)was used to assess the quality of recovery at 24 h after surgery of patients in both groups.The preoperative and 24 h postoperative levels of NK cells,CD4^(+)T and CD8^(+)T cells were compared between the two groups.Results The intraoperative infusion volume of remifentanil in the experimental group was significantly lower than that in the control group(P<0.05).There was no statistically significant difference in heart rate and mean arterial pressure between the two groups at T0,T1,T2,and T3(P>0.05).The body comfort,pain score,and levels of NK cells,CD4^(+)T and CD8^(+)T cells in the experimental group were significantly higher than those in the control group at 24 h after surgery(P<0.05).Conclusion Ultrasound-guided ESPB can reduce intraoperative opioid dosage,alleviate postoperative pain,improve postoperative cellular immune function,and promote early postoperative recovery in patients undergoing thoracoscopic lobectomy.