前锯肌平面阻滞对胸腔镜肺癌根治术后肺功能和免疫功能的影响

Effects of plane block of anterior serrated muscle on lung function and immune function after thoracoscopic radical resection of lung cancer

目的比较超声引导下前锯肌平面阻滞(SAPB)对胸腔镜下肺癌根治术后患者肺功能和免疫功能的影响。方法收集2020年1月至2023年2月在河北北方学院附属第一医院接受胸腔镜肺癌手术的135例患者,根据随机数字表法分为3组:对照组(n=45)仅接受全身麻醉,罗哌卡因组(n=45)在接受罗哌卡因局部浸润麻醉,SAPB组(n=45)接受SAPB。比较3组患者临床数据、手术资料,使用视觉模拟量表评分法(VAS)评估患者在静息和咳嗽时的疼痛情况,并收集围术期并发症发生情况。使用流式细胞仪和相应试剂检测患者术前、术后血清中T淋巴细胞亚群的水平、血清癌胚抗原(CEA)、癌胚抗原(CA)125、细胞角蛋白19片段21-1(CYFRA21-1)和神经元特异性烯醇化酶(NSE)水平。结果罗哌卡因组和SAPB组术中瑞芬太尼用量均低于对照组,首次按压患者自控镇痛(PCA)泵时间均晚于对照组,术后48小时内PCA泵按压次数均少于对照组,差异均有统计学意义(P<0.05)。3组患者不同时间点的静息、咳嗽VAS评分、CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)水平差异有统计学意义(P均<0.05)。术后24小时罗哌卡因组和SAPB组的CEA、CA125、CYFRA21-1和NSE水平均低于对照组(P均<0.05)。3组患者不良反应发生率分别为15.56%、4.44%和4.44%,差异无统计学意义(χ^(2)=4.949,P=0.084)。结论SAPB在提高胸腔镜下肺癌根治术后镇痛效果的同时,对调节患者机体免疫功能,降低血清肿瘤标志物水平有益。

Objective To compare the effects of ultrasound guided serratus anterior plane block(SAPB)on lung function and immune function in patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 135 patients undergoing thoracoscopic surgery for lung cancer in the First Affiliated Hospital of Hebei North University from January 2020 to February 2023 were collected.According to the random number,patients were divided into three groups randomly:the control group(n=45)who only received general anesthesia,the ropivacaine group(n=45)who received local infiltration anesthesia with ropivacaine,and the SAPB group(n=45)who received SAPB.Clinical data and surgical data were compared among the three groups.The visual analogue scale(VAS)was used to assess pain during rest and coughing.The perioperative complications were also collected.Flow cytometry and corresponding reagents were used to detect the levels of T lymphocyte subsets before and after surgery,as well as the levels of serum carcinoembryonic antigen(CEA),carcinoembryonic antigen(CA)125,cytokeratin 19 fragment 21-1(CYFRA21-1),and neuron specific enolase(NSE).Results The amount of remifentanil used during operation in the ropivacaine group and the SAPB group was lower than that in the control group,the time of the first press on the patient control analgesia(PCA)pump was later than that in the control group,and the number of press on the PCA pump within 48 hours after operation was lower than that in the control group,and the differences were all statistically significant(P<0.05).There were statistically significant differences in the level of VAS,CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)among three groups at different time points(all P<0.05).The level of CEA,CA125,CYFRA21-1 and NSE at 24 hours after surgery in the ropivacaine group and the SAPB group was lower than that in the control group(all P<0.05).The incidence of adverse reactions in three group was 15.56%,4.44%and 4.44%,respectively,with no statistically significant difference(χ^(2)=4.949,P=0.084).Conclusion SAPB can improve the analgesic effect after radical resection of lung cancer under thoracoscopy,regulate the immune function of patients and reduce the level of serum tumor markers.