摘要
目的 探讨全麻联合肋间神经阻滞(INB)对胸腔镜下肺叶切除患者术后镇痛、T淋巴细胞亚群的影响。方法 选取2019年10月至2022年10月河南省第二人民医院收治并拟行胸腔镜下肺叶切除的78例患者作为研究对象,按入院顺序编号并根据随机数表法分为单一组和联合组各39例,单一组患者实施全麻,联合组患者实施全麻联合INB,比较两组患者麻醉诱导前(T0)、术后30 min (T1)、术毕(T2)、术后2 h (T3)时的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、心排量(CO)情况;比较两组患者术前、术后6 h的血清血管紧张素-Ⅱ(AT-Ⅱ)、皮质醇(cort)水平;比较两组患者术后清醒即刻(T0 h)、6 h (T6 h)、12 h (T12 h)、24 h (T24 h)、48 h (T48 h)、72 h (T72 h)视觉模拟量表(VAS)评分和疼痛(PHPS)评分以及术前、术后24 h、术后72 h两组患者T淋巴细胞亚群指标CD4+、CD8+、CD4+/CD8+水平;同时比较两组患者的不良反应发生情况。结果 T1~T3时间点联合组患者的HR、MAP明显低于单一组,差异均有统计学意义(P<0.05);术后6 h,联合组患者的AT-Ⅱ、cort水平分别为(52.88±15.17) ng/mL、(294.19±19.50) ng/mL,明显低于单一组的(63.10±16.25) ng/mL、(338.73±20.47) ng/mL,差异均有统计学意义(P<0.05);术后T6 h~T72 h,联合组患者的VAS评分明显低于单一组,术后T0 h~T72 h,联合组患者的PHPS评分也明显低于单一组,差异均有统计学意义(P<0.05);联合组患者术后24 h、72 h的T淋巴细胞亚群指标CD4^(+)、CD4^(+)/CD8^(+)明显优于单一组,差异均有统计学意义(P<0.05),而CD8^(+)水平与单一组比较差异无统计学意义(P>0.05);联合组患者的不良反应总发生率为2.56%,明显低于单一组的20.51%,差异有统计学意义(P<0.05)。结论 全麻联合INB对胸腔镜下肺叶切除患者血流动力学影响较小,可抑制应激反应,发挥明显的术后镇痛效果,减轻T淋巴细胞亚群的抑制。
Objective To explore the influence of general anesthesia combined with intercostal nerve block(INB)on postoperative analgesia and T lymphocyte subsets in patients undergoing thoracoscopic lobectomy.Methods Seventy-eight patients who were scheduled to undergo thoracoscopic lobectomy in Henan Provincial Second People’s Hospital were selected as research subjects between October 2019 and October 2022,and the patients were numbered according to the order of admission and were divided into single group(39 cases)and combined group(39 cases)by means of the random number table method.The patients in single group were treated with general anesthesia,and the patients in combined group were given general anesthesia combined with INB.The heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),and cardiac output(CO)before induction of anesthesia(T0),at 30 min after surgery(T1),after the end of surgery(T2)and at 2 h after surgery(T3),levels of serum angiotensin-Ⅱ(AT-Ⅱ)and cortisol(cort)before surgery and at 6 h after surgery,Visual Analogue Scale(VAS)score and pain score(Prince Henry Pain Scale,PHPS)immediately(T0 h),6 h(T6 h),12 h(T12 h),24 h(T24 h),48 h(T48 h),and 72 h(T72 h)after recovery,T lymphocyte subsets indicators of CD4+,CD8+,and CD4+/CD8+before surgery and at 24 h and 72 h after surgery,and occurrence of adverse reactions were compared between the two groups of patients.Results The HR and MAP of patients in combined group at T1,T2,T3 were significantly lower than those in single group(P<0.05).At 6 h after surgery,the levels of AT-Ⅱand cort in combined group were(52.88±15.17)ng/mL,(294.19±19.50)ng/mL,significantly lower than(63.10±16.25)ng/mL,(338.73±20.47)ng/mL in single group(P<0.05).The VAS scores at T6 h,T12 h,T24 h,T48 h,T72 h in combined group were significantly lower compared with those in single group,and the PHPS scores at T0 h,T6 h,T12 h,T24 h,T48 h,T72 hT72h were significantly lower compared to that in single group(P<0.05).At 24 h and 72 h after surgery,the T lymphocyte subsets indicators of CD4^(+)and CD4^(+)/CD8^(+)in combined group were significantly better than those in single group(P<0.05),but there was no statistically significant difference in the level of CD8+compared with that in single group(P>0.05).The total incidence rate of adverse reactions of patients in combined group was 2.56%,which was significantly lower than 20.51%in single group(P<0.05).Conclusion General anesthesia combined with INB has little influence on hemodynamics in patients undergoing thoracoscopic lobectomy,and it can inhibit stress response,exert obvious postoperative analgesic effect,and relieve the suppression of T lymphocyte subsets.
作者
李博
李保华
李晓国
LI Bo;LI Bao-hua;LI Xiao-guo(Department of Anesthesiology,Henan Provincial Second People's Hospital,Xinzheng 451100,Henan,CHINA)
出处
《海南医学》
2024年第2期215-220,共6页
Hainan Medical Journal
基金
河南省自然科学基金(编号:2022YX6225)。
关键词
胸腔镜手术
肺叶切除
全麻
肋间神经阻滞
镇痛
T淋巴细胞亚群
Thoracoscopic surgery
Lobectomy
General analgesia
Intercostal nerve block
Analgesia
T lymphocyte subsets
