胸椎旁神经阻滞联合全麻对胸腔镜肺癌根治术患者炎症反应及免疫功能的影响

doi:10.3760/cma.j.issn.1007-1245.2023.21.010

摘要/Abstract

摘要：

目的　探讨胸椎旁神经阻滞联合全麻对胸腔镜肺癌根治术患者炎症反应及免疫功能的影响。方法　选取2021年9月1日至2023年3月31日邳州市人民医院收治的86例胸腔镜肺癌根治术患者，随机数字表法分为常规组、观察组，各43例。常规组男23例，女20例，年龄（49.54±7.23）岁；观察组男22例，女21例，年龄（50.11±6.67）岁。常规组给予全麻复合前锯肌平面阻滞，观察组给予全麻复合胸椎旁神经阻滞。统计两组术中血流动力学指标变化情况，对比两组炎症反应C反应蛋白（CRP）及降钙素原（PCT）水平及免疫功能情况，统计两组围手术期麻醉药物相关不良反应发生情况。结果　观察组与常规组麻醉诱导前（T0）、手术开始后5 min（T1）以及手术结束后5 min（T2）的心率和平均动脉压（MAP）变化，采用重复测量设计的方差分析：（1）不同时间点间的心率、MAP差异均有统计学意义（均P<0.05）；（2）观察组与常规组的心率、MAP差异均有统计学意义（均P<0.05），观察组与常规组相比心率、MAP比较低，相对血流动力学变化较小；（3）观察组与常规组的心率、MAP变化趋势差异均有统计学意义（均P<0.05）。术后48 h两组患者CRP及PCT水平均升高（均P<0.05），术后48 h观察组CRP及PCT水平均低于常规组（均P<0.05）。两组术后48 h的CD4⁺、CD4⁺/CD8⁺均低于术前，差异均有统计学意义（均P<0.05），观察组术后48 h的CD4⁺、CD4⁺/CD8⁺均高于常规组（均P<0.05）。常规组有5例恶心呕吐、3例头疼，总不良反应发生率为18.60%（8/43）；观察组有1例恶心呕吐、1例头痛，总不良反应发生率为4.65%（2/43）；观察组总不良反应发生率低于常规组，差异有统计学意义（χ²=4.074，P=0.044）。结论　胸椎旁神经阻滞联合全麻对胸腔镜肺癌根治术患者可稳定术中血流动力学指标，减轻炎症反应及免疫抑制，降低总不良反应发生率。

关键词:

胸腔镜肺癌根治术, 全麻, 胸椎旁阻滞, 前锯肌平面阻滞, 不良反应

Abstract:

Objective　To investigate the effects of thoracic paravertebral nerve block combined with general anesthesia on inflammatory response and immune function in patients undergoing thoracoscopic radical resection for lung cancer. Methods　A total of 86 patients undergoing thoracoscopic radical resection for lung cancer in Pizhou People's Hospital from September 1, 2021 to March 31, 2023 were randomly divided into a conventional group and an observation group, with 43 cases in each group. In the conventional group, there were 23 males and 20 females, aged (49.54±7.23) years. In the observation group, there were 22 males and 21 females, aged (50.11±6.67) years. The conventional group was given general anesthesia combined with serratus anterior plane block, while the observation group was given general anesthesia combined with thoracic paravertebral nerve block. The changes of intraoperative hemodynamic indexes in the two groups were analyzed, the levels of inflammatory C-reactive protein (CRP) and procalcitonin (PCT) and immune function of the two groups were compared, and the occurrence of perioperative anesthesia drug-related adverse reactions in the two groups were analyzed. Results　The changes of heart rate and mean arterial pressure (MAP) before anesthesia induction (T0), 5 minutes after surgery (T1), and 5 minutes after surgery (T2) were observed between the observation group and the conventional group using repeated measure design analysis of variance: (1) there were statistically significant differences in the heart rate and MAP between different time points (all P<0.05); (2) there were statistically significant differences in the heart rate and MAP between the observation group and the conventional group (all P<0.05); compared with those in the conventional group, the heart rate and MAP in the observation group were lower, and the relative hemodynamic change was little; (3) there were statistically significant differences in the change trends of heart rate and MAP between the observation group and the conventional group (all P<0.05). The levels of CRP and PCT in both groups were increased 48 h after surgery (all P<0.05), and the levels of CRP and PCT in the observation group were lower than those in the conventional group 48 h after surgery (both P<0.05). The levels of CD4⁺ and CD4⁺/CD8⁺ in the two groups 48 h after surgery were lower than those before surgery, with statistically significant differences (all P<0.05), and the levels of CD4⁺ and CD4⁺/CD8⁺ in the observation group 48 h after surgery were higher than those in the conventional group (both P<0.05). In the conventional group, there were 5 cases of nausea and vomiting and 3 cases of headache, and the total incidence of adverse reactions was 18.60% (8/43). In the observation group, there was 1 case of nausea and vomiting and 1 case of headache, and the total incidence of adverse reactions was 4.65% (2/43). The incidence of adverse reactions in the observation group was lower than that in the conventional group, with a statistically significant difference (χ²=4.074, P=0.044). Conclusion Thoracic paravertebral nerve block combined with general anesthesia can stabilize the intraoperative hemodynamic indexes, reduce the inflammatory response and immunosuppression, and reduce the incidence of total adverse reactions in patients undergoing thoracoscopic radical resection for lung cancer.

Key words:

Thoracoscopic radical resection for lung cancer, General anesthesia, Thoracic paravertebral block, Serratus anterior plane block, , Adverse reactions

丁雪邹丽峰许军焦烨.

胸椎旁神经阻滞联合全麻对胸腔镜肺癌根治术患者炎症反应及免疫功能的影响 [J]. 国际医药卫生导报, 2023, 29(21): 3030-3034.

Ding Xue, Zou Lifeng, Xu Jun, Jiao Ye.

Effect of thoracic paravertebral nerve block combined with general anesthesia on inflammatory response and immune function in patients undergoing thoracoscopic radical resection for lung cancer [J]. International Medicine and Health Guidance News, 2023, 29(21): 3030-3034.

参考文献

[1] 陈秀茹,林尧,吴碧玲,等.胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后痛觉过敏的影响[J].临床麻醉学杂志,2022,38(1):17-22.DOI:10.12089/jca.2022.01.004.
[2] 黄立峰,钱维明,徐琴,等.胸腔镜下肺癌根治患者术中体温变化曲线及对护理的启示[J].中华护理杂志,2022,57(20):2481-2486.DOI:10.3761/j.issn.0254-1769.2022.20.007.
[3] 刘辉,熊立红,徐晓晴,等.超声引导胸椎旁神经阻滞复合全身麻醉在开胸手术中的应用[J].局解手术学杂志,2023,32(7):621-624.DOI:10.11659/jjssx.10E022091.
[4] 周岚,黎鹏,宋绍永,等.超声引导下持续肋间神经阻滞对双孔胸腔镜手术患者术后早期恢复的影响[J].临床麻醉学杂志,2022,38(6):603-607.DOI:10.12089/jca.2022.06.008.
[5] 邱靖,蔡振.0.375％罗哌卡因联合帕瑞昔布钠前锯肌平面阻滞对胸腔镜手术术后疼痛的影响[J].中国临床药理学杂志,2022,38(15):1739-1742,1765.DOI:10.13699/j.cnki. 1001-6821.2022.15.009.
[6] 王若菡,康慷,李冰,等.术前联合术毕胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后早期康复质量的影响[J].重庆医学,2022,51(14):2383-2386.DOI:10.3969/j.issn.1671- 8348.2022.14.010.
[7] 程学峰,付泉源.超声引导下胸椎旁神经阻滞复合全麻对胸腔镜手术患者苏醒质量及术后镇痛的影响[J].临床合理用药杂志,2021,14(26):165-167. DOI:10.15887/j.cnki.13- 1389/r.2021.26.065.
[8] 王雁,邵建林,杨伟.不同剂量右美托咪定复合罗哌卡因胸椎旁神经阻滞在非插管胸腔镜手术中的比较[J].临床麻醉学杂志,2019,35(4):323-326.DOI:10.12089/jca.2019. 04.003.
[9] 唐彪,顾萍,李敏,等.胸椎旁神经阻滞在肺癌胸腔镜手术患者中的应用效果分析[J].贵州医药,2019,43(12):1882-1883.DOI:10.3969/j.issn.1000-744X.2019.12.009.
[10] 鲁清,程元骏,周孟虎.前锯肌平面阻滞和胸椎旁神经阻滞在胸腔镜手术中的麻醉效果及对疼痛因子的影响[J].中国现代医学杂志,2023,33(3):87-92.DOI:10.3969/j.issn.1005-8982.2023.03.014.
[11] 汤颜鞠,葛亚丽.前锯肌平面阻滞与胸椎旁阻滞用于胸外科手术患者术后镇痛效果的Meta分析[J].临床麻醉学杂志,2022,38(9):958-964.DOI:10.12089/jca.2022.09.013.
[12] 柴鸣,张同军,赵海蕊.直视下与超声引导下前路胸椎旁神经阻滞在老年患者开胸手术中的镇痛效果[J].中国老年学杂志,2023,43(4):825-828.DOI:10.3969/j.issn.1005-9202. 2023.04.015.
[13] 赵若林,梁丽丽,尚学栋,等.艾司氯胺酮联合胸椎旁神经阻滞对胸腔镜肺癌根治术后恢复质量的影响[J].临床麻醉学杂志,2023,39(7):677-682.DOI:10.12089/jca.2023.07.001.
[14] 白冰,黄宇光.手术和麻醉药物对肿瘤患者围手术期免疫功能的影响[J].中国免疫学杂志,2019,35(7):881-887.DOI:10.3969/j.issn.1000-484X.2019.07.023.
[15] 钟福如,周广文,何晓霞,等.胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者麻醉药物用量及术后疼痛的影响[J].中国医刊,2021,56(10):1110-1113.DOI:10.3969/j.issn.1008-1070.2021.10.018.
[16] 李军仕,安静,宋红伟,等.全身麻醉复合胸椎旁神经阻滞对胸腔镜肺癌根治术患者的麻醉效果和术后镇痛效果[J].癌症进展,2021,19(10):1019-1022.DOI:10.11877/j.issn.1672-1535.2021.19.10.11.
[17] 陈中刚,陈林,谭志敏.超声引导胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者术中镇痛药物使用量及氧化应激反应的影响[J].广州医科大学学报,2020,48(6):45-48,64.DOI:10.3969/j.issn.2095-9664.2020.06.11.
[18] 吴树彪,蔡莉娜,董铁立,等.胸椎旁神经阻滞与全身麻醉对胸腔镜肺癌根治术患者术后镇痛效果及血清相关肿瘤标志物水平的影响[J].中国老年学杂志,2018,38(3):611-614.DOI:10.3969/j.issn.1005-9202.2018.03.042.