Effects of continuous thoracic paravertebral block combined with general anesthesia on postoperative rehabilitation and immune function in lung cancer surgery
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摘要: 目的 探讨全身麻醉复合连续胸椎旁神经阻滞(CTPVB)对肺癌患者术后免疫功能及康复的影响。 方法 选择2016年2月—2018年2月肺癌患者102例,根据患者意愿将患者分为研究组(CTPVB复合全身麻醉,69例)和对照组(单纯全身麻醉,33例)。比较2组术后1 h、3 d及7 d血清疼痛介质、应激激素、免疫功能指标差异,以及患者术后康复差异。 结果 2组患者一般临床资料差异无统计学意义(均P>0.05)。术后1 h、术后第3天及术后第7天,研究组血清疼痛介质神经肽Y、5-羟色胺以及前列腺E2均显著低于对照组(均P<0.05),提示全麻复合CTPVB镇痛效果显著。术后1 h及术后第3天,研究组血清应激激素血管紧张素、促肾上腺皮质激素及皮质醇显著低于对照组(均P<0.05),免疫功能指标IgA、IgG及HLA-DR显著高于对照组(均P<0.05),提示全麻复合CTPVB可有效降低患者术后应激反应水平,降低肺癌患者术后免疫损伤程度。研究组在拔管后第3天的用力呼气量,拔管后第3天及第7天的氧合指数均显著高于对照组(P<0.05),提示全麻复合CTPVB对呼吸功能损伤较小,有利于患者术后康复。 结论 全麻复合CTPVB在肺癌患者手术中镇痛效果显著,可有效降低患者术后应激反应和免疫损伤程度,促进肺功能恢复,从而有助于患者术后康复。Abstract: Objective To investigate the effect of continuous thoracic paravertebral block (CTPVB) combined with general anesthesia on postoperative rehabilitation and immune function in lung cancer surgery, in order to provide theoretical basis for its clinical promotion. Methods From February 2016 to February 2018, 102 cases with open chest resection of lung cancer were continuously collected, and divided into study group (CTPVB combined with general anesthesia, n=69) and control group (single general anesthesia, n=33) according to patients' wishes. Differences in postoperative serum pain medium, stress hormone, immune function were compared between at 1st hour, 3rd and 7th day after operation, and postoperative rehabilitation differences also compared. Results No statistical differences were found in general clinical data and surgical data between two groups (all P>0.05). However, serum pain medium neuropeptide Y, 5-hydroxytryptamine and prostate E2 in the study group were significantly lower than those in the control group (all P<0.05) in the first hour, 3rd day and 7th day after operation. These indicated that CTPVB combined with general anesthesia had significant analgesic effect.Also, serum stress hormone angiotensin, adrenocorticotropic hormone, cortisol were significantly lower and immune function indexes IgA, IgG and HLA-DR in were significantly higher the study group than those in the control group (all P<0.05) in the first hour and 3rd day after operation. These suggested that the combination of general anesthesia with CTPVB can effectively reduce the level of postoperative stress response and the degree of postoperative immune injury in patients with lung cancer.Forced expiratory volume in the 3rd day after extubation and oxygenation index in the 3rd and 7th day after extubation in the study group was significantly higher than that in the control group (P<0.05). These suggested that the combination of general anesthesia with CTPVB has less damage to respiratory function, which was in favour of postoperative rehabilitation. Conclusion CTPVB combined with general anesthesia has a significant analgesic effect in the surgery of patients with lung cancer, moreover, can effectively reduce postoperative stress response and immune injury degree, promoted the recovery of lung function, thus contributed to the postoperative rehabilitation and worthy of clinical promotion.
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Key words:
- General anesthesia /
- Paravertebral nerve block /
- Lung cancer /
- Stress /
- Immune /
- Rehabilitation
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