摘要
目的探索不同时间点(切皮前、术毕后)行竖脊肌平面阻滞对胸腔镜下肺叶切除术后患者应激、免疫功能及肺功能的影响。方法前瞻性选取的117例胸腔镜下肺叶切除术患者,均在2019年1月至2020年10月期间收治,根据随机数字表法分为2组,两组均进行竖脊肌平面阻滞,对照组58例在手术结束后,拔管前完成;观察组59例在麻醉后切皮前完成,并比较两组术后48 h的肺功能以及T0(麻醉前)、T1(术毕即刻)、T2(术后24 h)、T3(术后48 h)时间段的免疫功能、应激反应、疼痛程度。结果观察组术后48 h的PEFR(4.89±1.16)L/min、FVC(2.65±0.15)L、FEV_(1)(1.62±0.21)L稳定情况更优于对照组,T1时段VAS评分(2.16±0.36)分,低于对照组。同时观察组T1、T2、T3时间段的CD^(+)_(8)、CD^(+)_(4)、CD^(+)_(3)水平高于对照组,皮质醇、E、NE水平低于对照组(P<0.05)。结论切皮前行竖脊肌平面阻滞,更能够稳定胸腔镜下肺叶切除术患者术后免疫功能、肺功能,减轻机体应激反应。
Objective To explore the effect of erector spinae plane block at different time points(before skin incision and after operation)on the stress,immune function,and lung function in patients after thoracoscopic lobectomy.Methods 117 patients undergoing thoracoscopic lobectomy were prospectively selected from January 2019 to October 2020,and they were divided into 2 groups according to the random number table method.Both groups received erector spinal muscle plane block.58 cases in the control group were completed after the operation and before extubation;59 cases in the observation group were completed after anesthesia and before the skin incision.The pulmonary function at 48 hours after the operation and the immune function,stress response,and pain degree at T0(before anesthesia),T1(immediately after operation),T2(24 hours after operation),and T3(48 hours after operation)were compared between the two groups.Results The stability of PEFR(4.89±1.16)L/min,FVC(2.65±0.15)L,and FEV_(1)(1.62±0.21)L of the observation group at 48 hours after the operation was better than that of the control group,and the VAS score during T1 period was(2.16±0.36)lower than in the control group.At the same time,the levels of CD^(+)_(8),CD^(+)_(4),and CD^(+)_(3) in the observation group during the T1,T2,and T3 periods were higher than those in the control group,and the levels of cortisol,E,and NE were lower than those in the control group(P<0.05).Conclusion The erector spinal muscle plane block before the skin incision can stabilize the postoperative immune function and lung function of patients undergoing thoracoscopic lobectomy,and reduce the body's stress response.
作者
金刚
沈亮
崔东海
Jin Gang;Shen Liang;Cui Dong-hai(Department of Anesthesiology,Fukuang General Hospital of Liaoning health industry group,Fushun,Liaoning 113000,China)
出处
《临床肺科杂志》
2022年第9期1307-1311,共5页
Journal of Clinical Pulmonary Medicine
基金
辽宁省科学技术计划项目(No.20190540649)。
关键词
竖脊肌平面阻滞
胸腔镜下肺叶切除术
应激反应
免疫功能
肺功能
erector spinae muscle plane block
thoracoscopic lobectomy
stress response
immune function
lung function
