超声引导下胸椎旁神经阻滞对单孔胸腔镜术后患者镇痛和细胞免疫的影响

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摘要目的探讨超声引导下胸椎旁神经阻滞（TPVB）阻滞对单孔胸腔镜下肺部分切除术后患者镇痛和细胞免疫功能的影响。方法选取2020年3—8月无锡市惠山区人民医院收治的60 例择期行单孔胸腔镜下肺部分切除术的患者作为研究对象，按照随机数字表法分成TPVB 组和对照组，每组各30 例。TPVB 组在全麻诱导插管后行超声引导下T4～5、T6～7 胸椎旁神经阻滞，确认无血、无气、无脑脊液后，分别注入0.5%的罗哌卡因10 mL。对照组在相同的胸椎旁间隙分别注入生理盐水10 mL。比较两组术中舒芬太尼和间羟胺的追加次数，术后24、48 h 的疼痛视觉模拟量表（VAS）评分，术后静脉自控镇痛（PCIA）的有效按压次数及麻醉诱导前、术后24、48 h CD4+、CD8+、CD3+的变化。结果 TPVB 组术中追加舒芬太尼及间羟胺的次数少于对照组，差异有统计学意义（P<0.05）。术后24、48 h，TVPB 组的VAS 评分均低于对照组，PCIA 有效按压次数均少于对照组，差异有统计学意义（P＜0.05）。麻醉诱导前两组的CD4+、CD8+、CD3+水平比较，差异无统计学意义（P＞0.05）；术后24 h，TPVB 组的CD4+、CD8+、CD3+水平均高于对照组，术后48 h，TPVB 组的CD8+、CD3+水平高于对照组，差异有统计学意义（P<0.05）。结论超声引导下单次胸椎旁神经阻滞可提高单孔胸腔镜下肺部分切除术后镇痛的效果，同时对T 淋巴细胞亚群水平进行有效的维持，减轻对患者细胞免疫的抑制。

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关键词 ：超声引导, 胸椎旁神经阻滞, 胸腔镜, 细胞免疫

Abstract：Objective To explore the effect of ultrasound-guided thoracic paravertebral block (TPVB) on analgesic and cellular immune function in patients with video-assisted single-hole thoracic surgery. Methods A total of 60 patients who underwent selective single-port thoracoscopic partial pneumonectomy in Wuxi Huishan District People′s Hospital from March to August 2020 were selected as the research subjects. According to random number table method, they were divided into TPVB group and control group, with 30 patients in each group. In TPVB group, T4-5, T6-7 thoracic paravertebral nerve block was performed under ultrasonic guidance after intubation induced by general anesthesia. After confirming that there was no blood, no gas, and no cerebrospinal fluid, 10 mL 0.5% ropivacaine was injected, respectively. In the control group, 10 mL of normal saline was injected into the same thoracic paravertebral space. The number of sufentanil and methydroxyamine additions during surgery, visual analogue scale (VAS) scores 24 and 48 h after surgery, the number of effective pressure on patient controlled intravenous analgesia (PCIA), and the changes of CD4+,CD8+and CD3+before and 24 and 48 h after anesthesia induction were compared between the two groups. Results The number of intraoperative sufentanil and hydroxyamine supplementation in TPVB group was less than that in control group, the difference was statistically significant (P<0.05). 24 and 48 h after surgery, the VAS scores of TVPB group were lower than the control group, and the effective times of PCIA compression were less than the control group, the differences were statistically significant (P<0.05). There was no significant difference in the levels of CD4+, CD8+ and CD3+ between the two groups before anesthesia induction (P>0.05). 24 h after operation, CD4+, CD8+, CD3+ levels in TPVB group were higher than those in control group, 48 h after operation, CD8+ and CD3+ levels in TPVB group were higher than those in control group, the differences were statistically significant (P<0.05). Conclusions Ultrasound-guided thoracic paravertebral nerve block can not only improve the effect of analgesia, but also maintain the T-lymphocyte subgroup level and reduce the inhibition of cellular immunity of patients with uniportal video-assisted thoracoscopic surgery.

Key words： Ultrasound-guided Thoracic paravertebal block;Video-assisted thoracoscopic surgery Cellular immune function

引用本文:

倪欣欣. 超声引导下胸椎旁神经阻滞对单孔胸腔镜术后患者镇痛和细胞免疫的影响[J]. 中国当代医药, 2021, 28(21): 156-159.
NI Xin-xin. Effect of ultrasound-guided thoracic paravertebral block on analgesic and cellular immune function in patients with video-assisted single-hole thoracic surgery. 中国当代医药, 2021, 28(21): 156-159.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I21/156

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