连续椎旁神经阻滞复合全麻对乳腺癌改良根治术患者细胞免疫功能的影响

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英文篇名：Effect of thoracic paravertebral block analgesia on cellular immune function in patients after breast cancer surgery 作者：肖萍 ; 汪利凤 ; 丁帅 ; 张蔚青 ; 胡翠月 ; 周大春 英文作者：XIAO Ping;WANG Lifeng;DING Shuai;Department of Anesthesiology, Hangzhou Municipal TCM Hospital; 关键词：连续椎旁神经阻滞麻醉 ; 术后镇痛 ; 细胞免疫 英文关键词：Analgesia thoracic paravertebral block;;Anesthesia General;;Immunity cellular 中文刊名：ZJYE 英文刊名：Zhejiang Medical Journal 机构：浙江中医药大学附属广兴医院(杭州市中医院)麻醉科;富阳市妇幼保健医院;浙江大学医学院附属邵逸夫医院麻醉科; 出版日期：2019-03-30 出版单位：浙江医学 年：2019 期：v.41 基金：浙江省医学会临床科研基金(2018ZYG-A40);; 杭州市科技局基金(20130633B21) 语种：中文; 页：ZJYE201906017 页数：4 CN：06 ISSN：33-1109/R 分类号：55-58

摘要

目的观察连续椎旁神经阻滞复合全麻对乳腺癌改良根治术的效果及对患者细胞免疫功能的影响。方法将40例择期行乳腺癌改良根治术患者采用随机数字表法分为全麻联合静脉镇痛(G组)与连续椎旁阻滞复合全麻组(GP组),每组20例。比较两组患者麻醉前(T_0)、术毕即刻(T_1)、术后24h(T_2)、术后72h(T_3)不同时点的T细胞亚群及NK细胞功能的变化,以及术后4、8、12、24、48h各时点安静、咳嗽时的疼痛评分(VAS评分)和镇静评分(Ra ms a y评分)。结果两组患者安静状态VAS评分差异无统计学意义(P>0.05);咳嗽时VAS评分GP组低于G组(P<0.05)。Ramsay评分与GP组比较G组患者评分较高(P<0.05或0.01)。两组除CD8+各指标术后均有所上升(P<0.01)外,其他细胞学指标(CD3~+、CD4~+、NK细胞)术后均有所下降(均P<0.05);GP组各指标在术后72h基本恢复术前水平(P>0.05),但G组仍未恢复,与术前比较有统计学差异。结论对于乳腺癌患者,选择连续椎旁神经阻滞复合全麻镇痛效果更好,免疫功能抑制较小且恢复较快。
        Objective To compare the effect of thoracic paravertebral block and intravenous analgesia on cellular immune function in breast cancer surgery patients. Methods Forty patients undergoing elective breast cancer surgery were randomly divided into two groups: patients in group G received total intravenous anesthesia followed by sulfentanil patient controlled intravenous analgesia and patients in group GP received general anesthesia combined with thoracic paravertebral block followed by post-op 0.25% ropivacain continuous paravertebral thoracic block analgesia. VAS pain scores at rest and coughing, and sedation scores were compared. Changes of T cell subsets and NK cell function were compared in 72 h after surgery. Results Post-op VAS scores at cough were significantly lower in group GP than that in group G. Ramsay score were lower in the G group(P<0.05). Lymphocyte subsets CD3~+, CD4~+ and NK cell were decreased and CD8~+ were increased in both groups postoperatively(P<0.05). At 72 h after surgery, the changes were recovered to the pre-op level in group GP but not in group G. Conclusion The immune function after breast cancer surgery was less suppressed and recovered earlier in patients with general anesthesia combined with paravertebral thoracic block anesthesia followed by post-op paravertebral thoracic block analgesia.

引文

[1]Neskovie V.Preoperative assessment of the immunocompromised patient[J].Acta Chir lugosl,2011,58(2):185-192.
    [2]Abdallah FW,Morgan PJ,Cil T,et al.Comparing the DN4 tool with the IASP grading system for chronic neuropathy pain screening after breast tumor resection with and without paravertebral blocks:a prospective 6-month validation study[J].Pain,2015,156(4):740-749.
    [3]Vacchelli E,Semeraro M,Adam J,et al.Immunosurveillance in esophageal carcinoma:The decisive impact of regulatory T cells[J].Oncoimmunology,2016,5(2):e1064581.
    [4]Jiang S,Yan W.T-cell immunometabolism against cancer[J].Cancer Lett,2016,382(2):255-258.
    [5]Byrne K,Levias Kj,Buggy DJ.Can anesthetic-analgesic technique during primary cancer surgery affect recurre nce or metastasis?[J].Can J Anaesth,2016,63(2):184-192.
    [6]Buckley A,Me Quaid S,Johnson P,et al.Effect of anaesthetic technique on the natural killer cell anti-tumour activity of serum from women undergoing breast cancer surgery:a pilot study[J].Br J Anaesth,2014,113(Suppl 1):i56-62.
    [7]Chen X,Lu P,Chen L,et al.Perioperative propofol-paravertebral anesthesia decreases the metastasis and progression of breast cancer[J].Tumour Biol,2015,36(11):8259-8266.
    [8]肖萍,张蔚青,周大春.连续胸椎旁神经阻滞复合全麻用于乳腺癌手术的麻醉及镇痛[J].浙江医学,2012,34(18):1509-1511.