Effect of ultrasound-guided paravertebral nerve block on cellular immune function during thoracotomy in patients with pulmonary tuberculosis
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摘要:
目的探讨超声引导下胸椎旁神经阻滞对肺结核患者开胸手术细胞免疫功能的影响。 方法60例择期行开胸手术肺结核患者，随机分为单纯全麻组（G组）和全麻复合超声引导下胸椎旁神经阻滞组（P组），30例/组。P组患者麻醉诱导前在超声引导下行单次胸椎旁神经阻滞，两组患者均采用静吸复合全麻维持麻醉，术毕行静脉自控镇痛。记录两组患者手术时间及失血量；记录两组患者术后6 h（T1）、12 h（T2）、24 h（T3）和72 h（T4）安静状态下和咳嗽时的视觉模拟评分；记录两组患者术前1 d和T1、T2、T3、T4的CD3+、CD4+、CD8+的百分率及CD4+/CD8+比值。 结果在安静和咳嗽状态下，P组患者在术后6、12 h视觉模拟评分均低于G组（P < 0.05）；两组患者CD3+、CD4+、CD8+、CD4+/CD8+在T1、T2、T3、T4时间点较术前均有下降（P < 0.05）；P组患者CD3+、CD4+、CD8+、CD4+/CD8+在T1、T2时间点较G组患者高（P < 0.05）。 结论超声引导下的胸椎旁神经阻滞可以减轻肺结核患者开胸术后早期疼痛，并可减轻患者术后的细胞免疫功能抑制。 Abstract:ObjectiveTo investigate the effect of ultrasound-guided paravertebral nerve block on cellular immune function during thoracotomy in patients with pulmonary tuberculosis. MethodsSixty patients with elective thoracotomy for pulmonary tuberculosis were randomly divided into the general anesthesia group alone (group G) and the general anesthesia combined with ultrasound-guided paravertebral nerve block group (group P), with 30 patients in each group. Patients in group P underwent a single ultrasound-guided thoracic paravertebral nerve block before anesthesia induction. Both groups were treated with intravenous controlled analgesia and intravenous inhalation combined with general anesthesia for maintenance anesthesia. Operation time and blood loss were recorded in the two groups. VAS scores were recorded at 6 h (T1), 12 h (T2), 24 h (T3) and 72 h (T4) after operation and at cough in both groups. The percentages of CD3+、CD4+、CD8+ and CD4+/ CD8+ of patients in the two groups were recorded one day (T0) before and T1, T2, T3, and T4 after surgery. ResultsUnder the condition of quiet and cough, the VAS of group P was lower than that of group G at 6 h and 12 h after operation (P < 0.05). CD3+, CD4+, CD8+ and CD4+/CD8+ decreased in T1, T2, T3 and T4 compared with the preoperative time points (T0) (P < 0.05).CD3+, CD4+, CD8+ and CD4+/CD8+ in group P were higher at T1 and T2 than in group G (P < 0.05). ConclusionUltrasound-guided thoracic paraspinal nerve block can reduce the early pain after thoracotomy in patients with pulmonary tuberculosis and reduce the cellular immunosuppression after thoracotomy. -
Key words:
- ultrasound /
- paravertebral nerve block /
- tuberculosis /
- immunologic function
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表 1 两组手术患者一般情况比较
Table 1. Comparison of patiens' general information (n=30, Mean±SD)
组别 性别(n) 年龄(岁) 体质量(kg) 男 女 G组 18 12 53.3±6.1 57.1±2.1 P组 16 14 51.4±9.3 58.4±1.9 G组:单纯全麻组; P组:全麻复合超声引导下胸椎旁神经阻滞组. 
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表 2 两组患者手术时间及失血量比较
Table 2. Comparison of patiens'operative time and blood loss (n= 30, Mean±SD)
组别 手术时间(min) 失血量(mL) G组 210±10.4 165±25.5 P组 225±9.5 175±20.3
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表 3 两组手术患者术后各时间点VAS评分比较
Table 3. Comparison of VAS scores at different time points after operation between the two groups (n=30, Mean±SD)
状态 组别 术后6 h 术后12 h 术后24 h 术后72 h 安静时 G组 2.1±0.1 3.4±0.7 4.6±0.3 2.7±0.9 P组 1.2±0.2* 2.1±0.3* 4.1±0.5 2.9±1.2 咳嗽时 G组 3.4±0.2 4.3±0.5 5.8±0.3 2.9±0.2 P组 2.1±0.6* 3.1±0.4* 5.3±0.2 3.0±0.5 *P < 0.05 vs G组.
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表 4 两组手术患者围术期免疫指标的变化比较
Table 4. Comparison of perioperative immune indexes between the two groups (n=30, Mean±SD)
指标 组别 T0 T1 T2 T3 T4 CD3+ (%) G组 62.3±4.1 40.7±4.9* 45.4±3.1* 50.3±2.9* 55.7±3.6* P组 63.8±4.5 49.2±7.1*Δ 50.1±6.5*Δ 51.4±3.1* 56.8±2.9* CD4+ (%) G组 35.8±7.3 21.4±4.7* 27.3±5.1* 28.4±3.7* 29.4±1.3* P组 36.3±5.6 29.3±2.7*Δ 36.3±1.2*Δ 29.3±2.9* 30.1±2.7* CD8+ (%) G组 27.2±5.1 20.3±2.4* 24.6±2.7* 22.1±4.1* 25.7±4.5* P组 28.1±4.4 24.5±3.6*Δ 31.4±2.8*Δ 22.4±3.1* 26.3±2.4* CD4+/CD8+ G组 1.3±0.5 0.9±0.6* 1.1±1.3* 1.2±0.4* 1.2±0.2* P组 1.4±0.8 1.1±0.7*Δ 1.2±1.8*Δ 1.3±0.3* 1.3±0.7* *P < 0.05 vs T0; ΔP < 0.05 vs G组.
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