| 钟祥鹏,刘 永,孙莹莹,李志超,查晓亮,马 欣.胸椎旁神经阻滞复合全麻对肝癌切除术患者术后镇痛效果、炎症应激反应和免疫功能的影响[J].,2023,(20):3846-3850 |
| 胸椎旁神经阻滞复合全麻对肝癌切除术患者术后镇痛效果、炎症应激反应和免疫功能的影响 |
| Effect of Thoracic Paravertebral Nerve Block Combined with General Anesthesia on Postoperative Analgesia, Inflammatory Stress Response and Immune Function in Patients undergoing Hepatectomy for Liver Cancer |
| 投稿时间：2023-04-23 修订日期：2023-05-18 |
| DOI：10.13241/j.cnki.pmb.2023.20.009 |
| 中文关键词: 肝癌 根治性手术 胸椎旁神经阻滞 炎症反应 免疫功能 镇痛 |
| 英文关键词: Liver cancer Radical surgery Thoracic paravertebral nerve block Inflammatory response Immune function Analgesia |
| 基金项目:广东省基础与应用基础研究基金项目（2020A1515010159） |
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| 中文摘要: |
| 摘要 目的：探讨胸椎旁神经阻滞（TPVB）复合全身麻醉在肝癌切除术的镇痛效果。方法：行肝癌切除术的患者120例根据麻醉方式不同分为对照组与TPVB组，每组60例。对照组实施单纯全身麻醉，TPVB组予以TPVB复合全身麻醉。记录两组术后4 h、术后12 h、术后24 h和术后48 h疼痛数字评价量表（NRS）评分；记录两组术中麻醉药物使用情况、术后镇痛相关指标；记录两组不良反应情况和首次排气时间、住院时间；分别于术前和术后24 h，检测患者血清白细胞介素-6（IL-6）和IL-8的测定并使用流式细胞仪对患者外周血T淋巴细胞亚群进行测定。结果：相比于对照组，TPVB组术后4 h、术后12 h和术后24 h的NRS评分均显著下降（P<0.05）。相比于对照组，TPVB组术中瑞芬太尼用量使用减少（P<0.05），首次按压镇痛泵时间延迟（P<0.05），术后24 h镇痛按压次数及用量减少（P<0.05），且补救镇痛率显著降低（P<0.05）。TPVB组术后首次排气时间相比对照组提前（P<0.05），住院时间相比对照组缩短（P<0.05），术后恶心呕吐发生率显著低于对照组（P<0.05）。在术后24 h时，两组IL-6水平和IL-8水平均高于术前（P<0.05），但TPVB组低于对照组（P<0.05）。在术后24 h时，两组CD3+、CD4+和CD4+/CD8+水平均低于术前（P<0.05），但TPVB组高于对照组（P<0.05）。结论：TPVB复合全麻用于肝癌切除术能够提高术后镇痛效果，减少围术期阿片类药物消耗，减轻术后炎症反应，改善术后免疫功能，对术后恢复有积极作用。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the analgesic effect of thoracic paravertebral nerve block (TPVB) combined with general anesthesia in liver cancer resection. Methods: 120 patients undergoing liver cancer resection were divided into a control group and a TPVB group based on different anesthesia methods, with 60 patients in each group. The control group received simple general anesthesia, and the TPVB group received TPVB combined with general anesthesia. The pain numerical rating scale (NRS) scores of the two groups were recorded at 4 h, 12 h, 24 h and 48 h after operation. The use of anesthetic drugs and postoperative analgesia related indicators in the two groups were recorded. The adverse reactions, first exhaust time and hospitalization time of the two groups were recorded. The serum levels of interleukin-6 (IL-6) and IL-8 were detected before and 24 hours after operation, and the peripheral blood T lymphocyte subsets were measured by flow cytometry. Results: Compared with the control group, the NRS scores of the TPVB group at 4 h, 12 h and 24 h after operation were significantly decreased (P<0.05). Compared with the control group, the amount of remifentanil used in the TPVB group was reduced (P<0.05), the time of first pressing the analgesic pump was delayed (P<0.05), the number and amount of analgesic pressing at 24 h after operation were reduced (P<0.05), and the remedial analgesia rate was significantly reduced (P<0.05). The first exhaust time in the TPVB group was earlier than that in the control group (P<0.05), the hospitalization time was shorter than that in the control group (P<0.05), and the incidence of postoperative nausea and vomiting was significantly lower than that in the control group (P<0.05). At 24 h after operation, the levels of IL-6 and IL-8 in the two groups were higher than those before operation (P<0.05), but the TPVB group was lower than the control group (P<0.05). At 24 h after operation, the levels of CD3+, CD4+ and CD4+/CD8+ in the two groups were lower than those before operation (P<0.05), but those in the TPVB group were higher than those in the control group (P<0.05). Conclusion: TPVB combined with general anesthesia for liver cancer resection can improve postoperative analgesia, reduce perioperative opioid consumption, reduce postoperative inflammatory response, improve postoperative immune function, and have a positive effect on postoperative recovery. |
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