胸椎旁神经阻滞联合全麻对腔镜下肺癌根治术后患者细胞免疫及疼痛的影响

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摘要目的探讨超声引导下胸椎旁神经阻滞联合全身麻醉对腔镜下肺癌根治术患者术后细胞免疫及疼痛的影响。方法选取2018年6月～2020年10月江西省人民医院收治的60 例肺癌患者为研究对象，按照随机数字表法分为P 组（30 例）和C 组（30 例）。C 组行全身麻醉，P 组行胸椎旁神经阻滞联合全身麻醉。比较两组患者术前，术毕，术后24、48 h 的T 淋巴细胞亚群（CD3+、CD4+、CD4+/CD8+），术中瑞芬太尼及丙泊酚用量，术后2、6、12、24、36 h 的咳嗽时视觉模拟量表（VAS）评分，术后12、24、48 h 静脉镇痛自控泵按压次数及术后补救镇痛率。结果两组术前及术后48 h 的T 淋巴细胞亚群水平比较，差异无统计学意义（P＞0.05）；P 组术毕及术后24 h 的CD3+、CD4+、CD4+/CD8+均高于C 组，差异有统计学意义（P＜0.05）。P 组瑞芬太尼及丙泊酚用量均少于C 组，差异有统计学意义（P＜0.05）。P 组术后2、6、12 h 咳嗽时VAS 评分低于C 组，差异有统计学意义（P＜0.05）。P 组患者术后12、24 h 自控泵按压次数少于C 组，P 组补救镇痛率低于C 组，差异有统计学意义（P＜0.05）。结论胸椎旁神经阻滞联合全身麻醉应用于胸腔镜肺癌根治术后患者，可提供满意的术中及术后镇痛效果，减少全身麻醉药的使用量，改善患者术后细胞免疫功能，值得临床推广应用。

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	郭善亮
	苏华凤
	刘艳龙
	范龙成
	况松涛
	张明生

关键词 ：胸椎旁神经阻滞, 全身麻醉, 肺癌根治术, 细胞免疫, 疼痛, 视觉模拟评分法

Abstract：Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia on postoperative cellular immunity and pain in patients undergoing endoscopic radical resection of lung cancer.Methods A total of 60 patients with lung cancer admitted to Jiangxi Provincial People′s Hospital from June 2018 to October 2020 were selected as the research subjects,and divided into group P(30 cases)and group C(30 cases)according to random number table method.Group C received general anesthesia,and group P received thoracic paravertebral nerve block combined with general anesthesia.T lymphocyte subsets(CD3+,CD4+,CD4+/CD8+),intraoperative amounts of remifentanil and propofol,and visual analog scale(VAS)scores at cough at 2,6,12,24 and 36 h after surgery,at 12,24,48 h postoperative intravenous analgesia pump pressure frequency and postoperative relief analgesia rate were compared between the two groups.Results There were no significant differences in the levels of T lymphocyte subsets before and 48 h after operation between the two groups(P＞0.05).CD3+,CD4+and CD4+/CD8+in group P were higher than those in group C after operation and 24 h after operation,the differences were statistically significant(P＜0.05).The dosage of Remifentanil and Propofol in group P were lower than those in group C,and the differences were statistically significant(P＜0.05).The VAS score of cough in group P were lower than those in group C at 2,6 and 12 h after operation,and the differences were statistically significant(P＜0.05).At 12,24 h after surgery,the frequency of automatic pump pressing in group P were less than those in group C,and the remedial analgesia rate in group P was lower than that in group C,the differences were statistically significant(P＜0.05).Conclusion Thoracic paravertebral nerve block combined with general anesthesia in patients with thoracoscopic radical resection of lung cancer can provide satisfactory intraoperative and postoperative analgesic effects,reduce the usage amount of general anesthesia,and improve the cellular immune function of patients after surgery,which is worthy of clinical promotion and application.

Key words： Thoracic paraspinal nerve block General anesthesia Radical resection of lung cancer Cellular immunity Pain Visual analogue scale

基金资助:江西省卫生计生委科技计划项目（20195035）

引用本文:

郭善亮;苏华凤;刘艳龙;范龙成;况松涛;张明生. 胸椎旁神经阻滞联合全麻对腔镜下肺癌根治术后患者细胞免疫及疼痛的影响[J]. 中国当代医药, 2021, 28(17): 8-11转19.
GUO Shan-liang; SU Hua-feng;LIU Yan-long; FAN Long-cheng; KUANG Song-tao; ZHANG Ming-sheng. Effect of thoracic paravertebral nerve block combined with general anesthesia on cellular immunity and pain in patients undergoing endoscopic radical resection of lung cancer. 中国当代医药, 2021, 28(17): 8-11转19.

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