摘要
目的观察超声引导下单次竖脊肌平面阻滞(ESPB)对行VATS肺叶切除手术的老年肺结核患者应激反应及免疫功能影响。方法选取2017-2019年本院择期行VATS肺叶切除术的老年肺结核患者60例,根据麻醉方法不同随机分为实验组(ESPB组)(n=30)和对照组(GA组)(n=30),实验组在超声引导下单次竖脊肌阻滞。分别于麻醉前(T_(0))、术毕即刻(T_(1))、术后1 d(T_(2))、术后3 d(T_(3))和术后5 d(T_(4))采集两组患者静脉血,采用流式细胞仪检测T淋巴细胞亚群并测定对应时间点的血糖(Glu)及皮质醇(Cor)水平。结果两组患者在术毕即刻(T_(1))、术后1 d(T_(2))、3 d(T_(3))血浆皮质醇和血糖水平均明显升高(P<0.05),ESPB组在术毕即刻(T_(1))、术后1 d(T_(2))升幅明显小于GA组(P<0.05);与麻醉前(T_(0))相比,术毕即刻(T_(1))、术后1 d(T_(2))、两组T细胞亚群均明显下降(P<0.01);术后3 d(T_(3))两组指标开始恢复,术后5 d(T_(4))ESPB组各项指标恢复接近麻醉前(T_(0))(P>0.05);ESPB组于术后3 d(T_(3))CD4^(+)、术后5 d(T_(4))CD3^(+),CD4^(+),CD4^(+)/CD8^(+)明显高于GA组(P<0.05)。结论超声引导下竖脊肌平面阻滞能够减轻胸腔镜肺叶切除术老年肺结核患者的手术创伤,减少应激反应,降低对免疫功能的抑制,利于患者的康复。
Objective To observe the effect of ultrasound-guided single erector spinal plane block(ESPB)on the stress response and immune function of elderly patients undergoing pulmonary tuberculosis and treated with VATS lobectomy.Methods A total of 60 elderly pulmonary tuberculosis patients who underwent elective VATS lobectomy in our hospital from 2017 to 2019 were selected and randomly divided into experimental group(group ESPB)(n=30)and control group(group GA)(n=30).The experimental group underwent a single erector spinal block under ultrasound guidance 20 minutes before induction of anesthesia,and were injected 20 ml of 0.5%ropivacaine injection.The two groups of patients were received intravenous analgesia pump routinely after operation.Venous blood was collected from the two groups of patients before anesthesia(T_(0)),immediately after the operation(T_(1)),1 day after operation(T_(2)),3 days after operation(T_(3))and 5 days after operation(T_(4)).T lymph cell subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))was detected by flow cytometry and the blood glucose(Glu)and cortisol(Cor)levels at the corresponding time points were measured.Results Plasma cortisol and blood glucose levels were significantly increased between two groups immediately after the operation(T_(1)),1d(T_(2)),and 3d(T_(3))after the operation(P<0.05).The increases in group ESPB were smaller at T_(1) time and T_(2) time than those of the GA group(P<0.05).Compared with levels before anesthesia(T_(0)),levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were significantly decreased in the two groups immediately after the operation(T_(1))and 1 day after the operation(T_(2))(P<0.01).At 3 days after operation(T_(3)),the indexes of the two groups began to recover.At 5 days after operation(T_(4)),the indexes of group ESPB recovered close to those before anesthesia(T_(0))(P>0.05).CD4^(+),CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the group ESPB at 3 days after operation(T_(3))and five days(T_(4))after operation were significantly higher than those in group GA(P<0.05).Conclusions Ultrasound-guided erector spinal muscle plane block can reduce the surgical trauma of elderly patients with pulmonary tuberculosis undergoing thoracoscopic lobectomy,reduce the stress response,reduce the suppression of immune function,and facilitate the recovery of patients.
作者
宗华
史少霞
哈斯艳·吐尔逊
高云飞
帕力哈提
刘磊
阿尔泰
ZONG Hua;SHI Shaoxia;Hasiyan Tuerxun;GAO Yunfei;Palihati`Rexiti;LIU Lei;Aertai(Department of anesthesiology,the Eighth Affiliated Hospital of Xinjiang Medical University,Urumqi,830049,China;Science and education section,the Eighth Affiliated Hospital of Xinjiang Medical University,Urumqi,830009,China)
出处
《新疆医学》
2022年第2期127-130,共4页
Xinjiang Medical Journal
基金
新疆维吾尔自治区自然科学基金(项目编号:2021D01A162)。
关键词
竖脊肌平面阻滞
老年
肺结核
应激
免疫
Erector spinal plane block
the elderly
Tuberculosis
Stress response
Immunity
