[1]陈 燕,和优娟,张东东,等.静脉自控镇痛联合胸椎旁神经阻滞对腹腔镜肝癌根治术患者细胞免疫功能及血清致痛物质水平的影响[J].陕西医学杂志,2022,51(2):186-190.[doi:DOI:10.3969/j.issn.1000-7377.2022.02.013]
　CHEN Yan,HE Youjuan,ZHANG Dongdong,et al.Effects of PCIA combined with thoracic paravertebral block on cellular immune function and levels of serum algogenic substances in patients undergoing laparoscopic radical resection for liver cancer[J].,2022,51(2):186-190.[doi:DOI:10.3969/j.issn.1000-7377.2022.02.013]
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静脉自控镇痛联合胸椎旁神经阻滞对腹腔镜肝癌根治术患者细胞免疫功能及血清致痛物质水平的影响
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年2期
页码:
186-190
栏目:
临床研究
出版日期:
2022-02-05

文章信息/Info

Title:
Effects of PCIA combined with thoracic paravertebral block on cellular immune function and levels of serum algogenic substances in patients undergoing laparoscopic radical resection for liver cancer
作者:
陈 燕1; 和优娟1; 张东东1; 田博振2; 石普峰2
(1.空军军医大学唐都医院麻醉科,陕西 西安 710038; 2.西安大兴医院麻醉科,陕西 西安 710016)
Author(s):
CHEN Yan; HE Youjuan; ZHANG Dongdong; TIAN Bozhen; SHI Pufeng
(Department of Anesthesiology,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)
关键词:
静脉自控镇痛;  胸椎旁神经阻滞;  腹腔镜肝癌根治术;  Ramsay镇静评分;  免疫功能;  致痛物质
Keywords:
Patient controlled intravenous analgesia;  Thoracic paravertebral block;  Laparoscopic radical resection for liver cancer;  Ramsay sedation score;  Immune function;  Algogenic substance
分类号:
R 614.2
DOI:
DOI:10.3969/j.issn.1000-7377.2022.02.013
文献标志码:
A
摘要:
目的:探讨静脉自控镇痛(PCIA)联合胸椎旁神经阻滞对腹腔镜肝癌根治术患者细胞免疫功能及血清致痛物质水平的影响。方法:选择行腹腔镜肝癌根治术肝癌患者66例,机分成观察组和对照组,每组33例; 对照组行PCIA,观察组实施PCIA联合胸椎旁神经阻滞; 于术后即刻(T1)、术后6 h(T2)、术后24 h(T3)和术后48 h(T4)采用疼痛视觉模拟量表(VAS)评分分析镇痛效果,采用Ramsay镇静评分分析镇静效果,采用流式细胞仪检测患者麻醉诱导前(T0)、T1、T2、T3和T4时刻的外周血CD3+、CD4+、CD8+、NK细胞水平以及计算CD4+/CD8+比值,采用酶联免疫吸附法检测T0、T1、T2、T3和T4时刻的血清5-羟色胺(5-HT)和P物质水平,记录患者术后不良反应。结果:术后两组T1～T4时间点CD3+、CD4+、NK细胞和CD4+/CD8+值均低于T0时,而观察组T2～T4时点CD3+、CD4+、NK细胞和CD4+/CD8+水平与对照组比较均有统计学差异(均P<0.05)。与T0时刻相比,两组患者T1～T4时刻血清5-HT和P物质水平明显升高(均P<0.05)。观察组T1～T4时刻血清5-HT和P物质水平低于对照组(均P<0.05)。观察组患者不良反应发生率9.09%显著低于对照组的21.21%(P<0.05)。结论:PCIA联合胸椎旁神经阻滞可有效提高腹腔镜肝癌根治术患者的细胞免疫功能,抑制术后致痛物质水平,镇痛镇静效果良好,不良反应少。
Abstract:
Objective:To analyze the effects of patient controlled intravenous analgesia(PCIA)combined with thoracic paravertebral block(TPVB)on cellular immune function and levels of serum algogenic substances in patients undergoing laparoscopic radical resection for liver cancer.Methods:A total of 66 patients undergoing laparoscopic radical resection for liver cancer.They were randomly divided into observation group and control group,33 cases in each group.The control group underwent PCIA,while observation group underwent PCIA combined with TPVB.Immediately after surgery(T1),at 6 hours after surgery(T2),24 hours after surgery(T3)and 48 hours after surgery(T4),analgesic effect was analyzed by VAS.The sedation effect was analyzed by Ramsay sedation score.The levels of peripheral blood CD3+,CD4+,CD8+ and NK cells were detected by flow cytometry at T0,T1,T2,T3 and T4,and CD4+/CD8+ ratio was calculated.The levels of serum 5-hydroxytryptamine(5-HT)and substance P were detected by enzyme-linked immunosorbent assay at T0,T1,T2,T3 and T4.The postoperative adverse reactions were recorded.Results:The two groups of CD3+,CD4+,NK cells and CD4+/CD8+ at T1 to T4 were all lower than those at T0,and the differences in CD3+,CD4+,NK cells and CD4+/CD8+ at T2 to T4 between the two groups were statistically significant(all P<0.05).The levels of serum 5-HT and substance P in both groups were significantly higher at T1 to T4 than those at T0(all P<0.05).At T1 to T4,the levels of serum 5-HT and substance P in observation group were lower than those in control group(all P<0.05).The incidence of adverse reactions in observation group was lower than that in control group(9.09% vs. 21.21%,P<0.05).Conclusion:PCIA combined with TPVB can effectively improve immune function and inhibit the levels of algogenic substances in patients undergoing laparoscopic radical resection for liver cancer,with good analgesic and sedative effects,and fewer adverse reactions.

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备注/Memo

备注/Memo:
基金项目:陕西省科技计划项目(2020SF-068)
更新日期/Last Update: 2022-02-09