胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛及免疫细胞功能的影响

发布时间：2018-02-22 08:50

本文关键词： 胸腔镜肺癌根治术神经阻滞镇痛细胞免疫　出处：《中国现代医学杂志》2017年22期 　论文类型：期刊论文

【摘要】：目的探讨胸椎旁神经阻滞复合全身麻醉对胸腔镜肺癌根治术患者镇痛及免疫细胞功能的影响。方法 87例择期行胸腔镜肺癌根治术患者随机分为全身麻醉组(n=43)和复合组(n=44),全身麻醉组患者采用单纯静吸复合全身麻醉下胸腔镜肺癌根治术,复合组患者则在全身麻醉组基础上,于麻醉诱导前行胸椎旁神经阻滞,两组患者均于术毕行自控静脉镇痛(PCIA)。记录两组患者术中瑞芬太尼用量,记录两组患者术后2、24和48 h时VAS评分情况,记录两组患者术后24和48 h时PCIA自控按钮启动次数及输注量,分别于麻醉诱导前或复合组神经阻滞前(T_0)、气管拔管即刻(T_1)、术后24 h(T_2)、48 h(T_3)和72 h(T_4)时,监测静脉血T淋巴细胞亚群CD3~+、CD4~+、CD8~+和NK细胞,并计算CD4~+/CD8~+值。结果复合组患者术后2和24 h时视觉模拟评分(VAS)与全身麻醉组比较,差异有统计学意义(P0.05),复合组均低于全身麻醉组;复合组患者术后24和48 h时PCIA自控按钮启动次数和地佐辛输注量与全身麻醉组比较,差异有统计学意义(P0.05),复合组均低于全身麻醉组;与T_0时比较,两组患者T_(1～4)时CD3~+、CD4~+、CD4~+/CD8~+比值和NK细胞水平均降低,差异有统计学意义(P0.05);与全身麻醉组比较,复合组患者T_(2～4)时CD3~+、CD4~+、CD4~+/CD8~+比值和NK细胞水平均升高,差异有统计学意义(P0.05)。结论胸椎旁神经阻滞复合全身麻醉可有效减轻胸腔镜肺癌根治术患者术后疼痛,减少术后阿片类药物用量,有助于改善患者术后免疫功能。
[Abstract]:Objective to investigate the thoracic paravertebral block combined with general anesthesia effect of radical resection of analgesic and immune cell function in patients with thoracoscopic lung cancer. Methods for 87 patients undergoing thoracoscopic resection of lung cancer patients were randomly divided into general anesthesia group (n=43 group) and compound (n=44), general anesthesia group were treated by simple general anesthesia under the chest mirror lung resection, composite group patients in the general anesthesia group based on the induction of anesthesia on thoracic paravertebral block, two patients were in operation for patient-controlled intravenous analgesia (PCIA). Recorded in two groups of patients with remifentanil, recording two groups of patients after 2,24 and 48 h VAS score and record the two groups of patients after 24 and 48 h PCIA in the control button to start the number and volume of infusion, respectively before induction of anesthesia or combined nerve block group (T_0), tracheal extubation (T_1), 24 h after operation (T_2), 48 h (T_3) and 72 h (T_4) when the prison Measurement of venous blood T lymphocyte subsets CD3~+, CD4~+, CD8~+ and NK cells, and CD4~+/CD8~+ was calculated. Results the patients after the 2 composite group and 24 h visual analogue scale (VAS) and general anesthesia group, the difference was statistically significant (P0.05), composite group were lower than the general anesthesia group; the patients group after 24 and 48 h PCIA automatic start button and the number of dezocine transfusion and general anesthesia group, the difference was statistically significant (P0.05), composite group were lower than the general anesthesia group; compared with T_0, two patients in group T_ (1~4) CD3~+, CD4~+, CD4~+/ CD8~+ ratio and NK cells were decreased, the difference was statistically significant (P0.05); group compared with general anesthesia, combined group of patients with T_ (2~4) CD3~+, CD4~+, CD4~+/CD8~+ ratio and NK cell levels were elevated, the difference was statistically significant (P0.05). Conclusion thoracic paravertebral block combined with general anesthesia can effectively relieve thoracoscopic lung The postoperative pain and the reduction of opioid dosage after radical operation can help to improve the postoperative immune function of the patients.

【作者单位】：河南省新乡市中心医院;中国医科大学附属第四医院;
【基金】：辽宁省自然科学基金(No:2013021071)
【分类号】：R614;R734.2

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