摘要
目的研究胸段椎旁阻滞联合静脉自控镇痛系统与单纯静脉自控镇痛对腹腔镜肝癌切除术后镇痛和免疫功能的效果。方法选择2016年1—12月于本院进行腹腔镜下肝癌切除术患者83例,男39例,女44例,年龄42~61岁, BMI 20~27 kg/m2,ASA Ⅰ或Ⅱ级。根据术后镇痛方式分为胸段椎旁阻滞(thoracic paravertebral block,TPVB)联合患者静脉自控镇痛(patient-controlled intravenous analgesia, PCIA)组(T组,n=43)和单纯PCIA组(S组,n=40)。T组给予TPVB联合PCIA处理,S组给予单纯PCIA处理。分别于术前4 h、术后24、72 h和术后7 d记录疼痛强度量表(numeric rating scale,NRS)评分,同时抽取患者静脉血,采用ELISA法检测血清中P物质(SP)、神经肽 Y(NPY)、多巴胺(DA)和去甲肾上腺素(NE)等浓度,白细胞介素IL-1β(IL-1β)、白细胞介素IL-6(IL-6)、白细胞介素IL-8(IL-8)等浓度,采用流式细胞术检测CD4^+T细胞、CD8^+T细胞比例并计算CD4^+/CD8^+。记录术后舒芬太尼用量和PCIA按压次数。记录术后睡眠不良、肺炎、肝功能延迟恢复等不良反应情况。结果术后24、72 h和术后7 d T组NRS评分明显少于S组(P<0.05)。术后24和72 h T组的IL-1β、IL-6和IL-8浓度明显低于S组(P<0.05),SP、NPY、DA和NE浓度明显低于S组(P<0.05)。术后72 h时T组CD4^+/CD8^+明显高于S组(P<0.05)。T组舒芬太尼用量和PCIA按压次数明显少于S组(P<0.05),睡眠不良的发生率明显低于S组(P<0.05)。结论与单纯PCIA比较,TPVB联合PCIA在减少术后阿片类镇痛药物使用量的同时提高腹腔镜肝癌术后患者的疼痛控制效果,并明显降低炎性因子和疼痛介质的释放,改善CD4+/CD8+倒置现象。
Objective To study the effect of thoracic paravertebral block combined patient-controlled intravenous analgesia on postoperative analgesia of patients undergoing laparoscopic hepatectomy. Methods Eighty three liver cancer patients, 39 males and 44 females, aged 42-61 years, BMI 20-27 kg/m^2, ASA physical status I or II undergoing laparoscopic hepatectomy from January to December in 2016 were enrolled in this study. According to the postoperative analgesia, all patients were divided into two groups: the combination group(group T, n = 43) who received thoracic paravertebral block(TPVB) combined with patient-controlled intravenous analgesia(PCIA) and the simple group(group S, n = 40) who received PCIA alone. The patients’ numeric rating scale(NRS) 4 h before operation and 24, 72 h or 7 d after operation between the two groups were recorded and compared. The venous blood of patients was collected to detect the ratio of CD4^+/CD8^+ cells, the levels of serum pain mediators such as neuropeptide Y(NPY), dopamine(DA), and norepinephrine(NE), interleukin IL-1β(IL-1β), interleukin IL-6(IL-6), and interleukin IL-8(IL-8) by flow cytometry and ELISA. The amount of sufentanil used and the number of PCIA compressions were recorded, and adverse reactions such as postoperative sleep, pneumonia, and delayed liver function recovery were recorded. Results The NRS scores of group T were significantly lower than those of group S 24, 72 h and 7 d after surgery(P < 0.05). The levels of IL-1β, IL-6 and IL-8 in group T were significantly lower than those in group S 24 and 72 h after operation(P < 0.05). The concentrations of SP, NPY, DA and NE were significantly lower than those in group S(P < 0.05). Furthermore, the CD4^+/CD8^+ in group T was significantly higher than that in group S at 72 h after surgery(P < 0.05). Meanwhile, the dose of sufentanil and PCIA compression in group T were significantly lower than those in group S(P < 0.05), and the incidence of sleep failure was significantly lower than that in group S(P < 0.05). Concl
作者
南忠庆
张明晓
刘建龙
NAN Zhongqing;ZHANG Mingxiao;LIU Jianlong(Department of Anesthesiology, Wenzhou City Central Hospital ,Wenzhou 325100, China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2019年第7期685-689,共5页
Journal of Clinical Anesthesiology
关键词
胸椎椎旁阻滞
静脉自控镇痛
术后疼痛
CD4^+/CD8^+
Thoracic paravertebral block
Patient-controlled intravenous analgesia
Postoperative pain
CD4^+/CD8^+
