本文關(guān)鍵詞： 胸腔鏡肺癌根治術(shù) 神經(jīng)阻滯 鎮(zhèn)痛 細(xì)胞免疫　出處：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2017年22期 　論文類型：期刊論文

【摘要】：目的探討胸椎旁神經(jīng)阻滯復(fù)合全身麻醉對(duì)胸腔鏡肺癌根治術(shù)患者鎮(zhèn)痛及免疫細(xì)胞功能的影響。方法 87例擇期行胸腔鏡肺癌根治術(shù)患者隨機(jī)分為全身麻醉組(n=43)和復(fù)合組(n=44),全身麻醉組患者采用單純靜吸復(fù)合全身麻醉下胸腔鏡肺癌根治術(shù),復(fù)合組患者則在全身麻醉組基礎(chǔ)上,于麻醉誘導(dǎo)前行胸椎旁神經(jīng)阻滯,兩組患者均于術(shù)畢行自控靜脈鎮(zhèn)痛(PCIA)。記錄兩組患者術(shù)中瑞芬太尼用量,記錄兩組患者術(shù)后2、24和48 h時(shí)VAS評(píng)分情況,記錄兩組患者術(shù)后24和48 h時(shí)PCIA自控按鈕啟動(dòng)次數(shù)及輸注量,分別于麻醉誘導(dǎo)前或復(fù)合組神經(jīng)阻滯前(T_0)、氣管拔管即刻(T_1)、術(shù)后24 h(T_2)、48 h(T_3)和72 h(T_4)時(shí),監(jiān)測(cè)靜脈血T淋巴細(xì)胞亞群CD3~+、CD4~+、CD8~+和NK細(xì)胞,并計(jì)算CD4~+/CD8~+值。結(jié)果復(fù)合組患者術(shù)后2和24 h時(shí)視覺模擬評(píng)分(VAS)與全身麻醉組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),復(fù)合組均低于全身麻醉組;復(fù)合組患者術(shù)后24和48 h時(shí)PCIA自控按鈕啟動(dòng)次數(shù)和地佐辛輸注量與全身麻醉組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05),復(fù)合組均低于全身麻醉組;與T_0時(shí)比較,兩組患者T_(1～4)時(shí)CD3~+、CD4~+、CD4~+/CD8~+比值和NK細(xì)胞水平均降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);與全身麻醉組比較,復(fù)合組患者T_(2～4)時(shí)CD3~+、CD4~+、CD4~+/CD8~+比值和NK細(xì)胞水平均升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論胸椎旁神經(jīng)阻滯復(fù)合全身麻醉可有效減輕胸腔鏡肺癌根治術(shù)患者術(shù)后疼痛,減少術(shù)后阿片類藥物用量,有助于改善患者術(shù)后免疫功能。
[Abstract]:Objective to investigate the thoracic paravertebral block combined with general anesthesia effect of radical resection of analgesic and immune cell function in patients with thoracoscopic lung cancer. Methods for 87 patients undergoing thoracoscopic resection of lung cancer patients were randomly divided into general anesthesia group (n=43 group) and compound (n=44), general anesthesia group were treated by simple general anesthesia under the chest mirror lung resection, composite group patients in the general anesthesia group based on the induction of anesthesia on thoracic paravertebral block, two patients were in operation for patient-controlled intravenous analgesia (PCIA). Recorded in two groups of patients with remifentanil, recording two groups of patients after 2,24 and 48 h VAS score and record the two groups of patients after 24 and 48 h PCIA in the control button to start the number and volume of infusion, respectively before induction of anesthesia or combined nerve block group (T_0), tracheal extubation (T_1), 24 h after operation (T_2), 48 h (T_3) and 72 h (T_4) when the prison Measurement of venous blood T lymphocyte subsets CD3~+, CD4~+, CD8~+ and NK cells, and CD4~+/CD8~+ was calculated. Results the patients after the 2 composite group and 24 h visual analogue scale (VAS) and general anesthesia group, the difference was statistically significant (P0.05), composite group were lower than the general anesthesia group; the patients group after 24 and 48 h PCIA automatic start button and the number of dezocine transfusion and general anesthesia group, the difference was statistically significant (P0.05), composite group were lower than the general anesthesia group; compared with T_0, two patients in group T_ (1~4) CD3~+, CD4~+, CD4~+/ CD8~+ ratio and NK cells were decreased, the difference was statistically significant (P0.05); group compared with general anesthesia, combined group of patients with T_ (2~4) CD3~+, CD4~+, CD4~+/CD8~+ ratio and NK cell levels were elevated, the difference was statistically significant (P0.05). Conclusion thoracic paravertebral block combined with general anesthesia can effectively relieve thoracoscopic lung The postoperative pain and the reduction of opioid dosage after radical operation can help to improve the postoperative immune function of the patients.

【作者單位】： 河南省新鄉(xiāng)市中心醫(yī)院;中國(guó)醫(yī)科大學(xué)附屬第四醫(yī)院;
【基金】：遼寧省自然科學(xué)基金(No:2013021071)
【分類號(hào)】：R614;R734.2

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