连续胸椎旁神经阻滞复合全身麻醉对肺癌患者术后康复和免疫功能的影响
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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。
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 1 st hour, 3 rd and 7 th 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, 3 rd day and 7 th 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 3 rd 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 3 rd day after extubation and oxygenation index in the 3 rd and 7 th 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.
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 1 st hour, 3 rd and 7 th 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, 3 rd day and 7 th 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 3 rd 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 3 rd day after extubation and oxygenation index in the 3 rd and 7 th 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.
引文
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[13]LIU J Y,GUO F,WU H L,et al.Midazolam anesthesia protects neuronal cells from oxidative stress-induced death via activation of the JNK-ERK pathway[J].Mol Med Rep,2017,15(1):169-179.
[14]HELANDER E M,WEBB M P,BIAS M,et al.Use of regional anesthesia techniques:analysis of institutional enhanced recovery after surgery protocols for colorectal surgery[J].J Laparoendosc Adv Surg Tech A,2017,27(9):898-902.
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[16]OKAJIMA H,TANAKA O,USHIO M,et al.Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery[J].J Anesth,2015,29(3):373-378.
[17]WANG L D,GAO X,LI J Y,et al.Effects of preemptive analgesia with parecoxib sodium on haemodynamics and plasma stress hormones in surgical patients with thyroid carcinoma[J].Asian Pac J Cancer Prev,2015,16(9):3977-3980.
[18]PAN Y S,HU Y F,TIAN F B,et al.Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery:a randomized controlled study[J].Int J Clin Exp Med,2015,8(6):9862-9868.
[19]ZHANG Y S,JIN L J,ZHOU X,et al.Effect of dexmedetomidine on stress reactions and cellular immune function of patients in perioperative period following radial resection for rectal carcinoma[J].J Biol Regul Homeost Agents,2018,32(1):139-145.
[20]MATSUBARA C,MURAKAMI H,IMAI K,et al.Prevalence and risk factors for post-traumatic stress reaction among resident survivors of the tsunami that followed the great east Japan earthquake,March 11,2011[J].Disaster Med Public Health Prep,2016,10(5):746-753.
[21]LIU H F,GAO L,LIU T,et al.Comparison of acute phase reaction and postoperative stress in pigs undergoing video-assisted thoracoscopic versus thoracotomy pneumonectomy[J].Acta Vet Scand,2016,58(1):75.
[22]BUHK C,KAMMER M,BEIERKUHNLEIN C,et al.On the influence of provenance to soil quality enhanced stress reaction of young beech trees to summer drought[J].Ecol Evol,2016,6(22):8276-8290.
[23]KOSIN'SKI S,FRYZ'LEWICZ E,WIKOJ C'M,et al.Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy:a randomised,non-inferiority trial[J].Anaesthesiol Intensive Ther,2016,48(5):280-287.
[24]TAKETA Y,FUJITANI T.Ultrasound-guided high-thoracic paravertebral block relieves referred pain caused by cervical spondylosis and provides stellate ganglion-blocking effect[J].J Clin Anesth,2016,34:490-491.
[25]KULHARI S,BHARTI N,BALA I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy:a randomized controlled trial[J].Br J Anaesth,2016,117(3):382-386.
[26]DIAZ A,LEDESMA B,GILSANZ F.Thoracic paravertebral block plus pectoral nerve block for mastectomy in a patient with advanced amyotrophic lateral sclerosis[J].Rev Esp Anestesiol Reanim,2014,61(3):172-173.
[27]GAUTAM S K S,DAS P K,AGARWAL A,et al.Comparative evaluation of continuous thoracic paravertebral block and thoracic epidural analgesia techniques for post-operative pain relief in patients undergoing open nephrectomy:a prospective,randomized,single-blind study[J].Anesth Essays Res,2017,11(2):359-364.
[2]WANG Z,WANG Y,HUANG Y,et al.Challenges and research opportunities for lung cancer screening in China[J].Cancer Commun(Lond),2018,38(1):34.
[3]WANG S,WANG X,ZHOU Q,et al.Stereotactic ablative radiotherapy versus lobectomy for stageⅠnon-small cell lung cancer:a systematic review[J].Thorac Cancer,2018,9(3):337-347.
[4]RAMAN V,YANG C J,DENG J Z,et al.Surgical treatment for early stage non-small cell lung cancer[J].J Thorac Dis,2018,10(Suppl7):S898-S904.
[5]TABCHI S,KASSOUF E,RASSY E E,et al.Management of stageⅢnon-small cell lung cancer[J].Semin Oncol,2017,44(3):163-177.
[6]SHANAHAN J L,LEISSNER K B.Prehabilitation for the enhanced recovery after surgery patient[J].J Laparoendosc Adv Surg Tech A,2017,27(9):880-882.
[7]NIMMO S M,FOO I T H,PATERSON H M.Enhanced recovery after surgery:Pain management[J].J Surg Oncol,2017,116(5):583-591.
[8]KARMAKAR M K,SAMY W,LEE A,et al.Survival analysis of patients with breast cancer undergoing a modified radical mastectomy with or without a thoracic paravertebral block:a 5-year follow-up of a randomized controlled trial[J].Anticancer Res,2017,37(10):5813-5820.
[9]SENTURK J C,KRISTO G,GOLD J,et al.The development of enhanced recovery after surgery across surgical specialties[J].J Laparoendosc Adv Surg Tech A,2017,27(9):863-870.
[10]PISARSKA M,MALCZAK P,MAJOR P,et al.Enhanced recovery after surgery protocol in oesophageal cancer surgery:Systematic review and meta-analysis[J].PLo S One,2017,12(3):e0174382.
[11]PADURARU M,PONCHIETTI L,CASAS I M,et al.Enhanced recovery after surgery(ERAS)-the evidence in geriatric emergency surgery:a systematic review[J].Chirurgia(Bucur),2017,112(5):546-557.
[12]LEISSNER K B,SHANAHAN J L,BEKKER P L,et al.Enhanced recovery after surgery in laparoscopic surgery[J].J Laparoendosc Adv Surg Tech A,2017,27(9):883-891.
[13]LIU J Y,GUO F,WU H L,et al.Midazolam anesthesia protects neuronal cells from oxidative stress-induced death via activation of the JNK-ERK pathway[J].Mol Med Rep,2017,15(1):169-179.
[14]HELANDER E M,WEBB M P,BIAS M,et al.Use of regional anesthesia techniques:analysis of institutional enhanced recovery after surgery protocols for colorectal surgery[J].J Laparoendosc Adv Surg Tech A,2017,27(9):898-902.
[15]GROSU I,LAVAND’HOMME P.Continuous regional anesthesia and inflammation:a new target[J].Minerva Anestesiol,2015,81(9):1001-1009.
[16]OKAJIMA H,TANAKA O,USHIO M,et al.Ultrasound-guided continuous thoracic paravertebral block provides comparable analgesia and fewer episodes of hypotension than continuous epidural block after lung surgery[J].J Anesth,2015,29(3):373-378.
[17]WANG L D,GAO X,LI J Y,et al.Effects of preemptive analgesia with parecoxib sodium on haemodynamics and plasma stress hormones in surgical patients with thyroid carcinoma[J].Asian Pac J Cancer Prev,2015,16(9):3977-3980.
[18]PAN Y S,HU Y F,TIAN F B,et al.Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery:a randomized controlled study[J].Int J Clin Exp Med,2015,8(6):9862-9868.
[19]ZHANG Y S,JIN L J,ZHOU X,et al.Effect of dexmedetomidine on stress reactions and cellular immune function of patients in perioperative period following radial resection for rectal carcinoma[J].J Biol Regul Homeost Agents,2018,32(1):139-145.
[20]MATSUBARA C,MURAKAMI H,IMAI K,et al.Prevalence and risk factors for post-traumatic stress reaction among resident survivors of the tsunami that followed the great east Japan earthquake,March 11,2011[J].Disaster Med Public Health Prep,2016,10(5):746-753.
[21]LIU H F,GAO L,LIU T,et al.Comparison of acute phase reaction and postoperative stress in pigs undergoing video-assisted thoracoscopic versus thoracotomy pneumonectomy[J].Acta Vet Scand,2016,58(1):75.
[22]BUHK C,KAMMER M,BEIERKUHNLEIN C,et al.On the influence of provenance to soil quality enhanced stress reaction of young beech trees to summer drought[J].Ecol Evol,2016,6(22):8276-8290.
[23]KOSIN'SKI S,FRYZ'LEWICZ E,WIKOJ C'M,et al.Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy:a randomised,non-inferiority trial[J].Anaesthesiol Intensive Ther,2016,48(5):280-287.
[24]TAKETA Y,FUJITANI T.Ultrasound-guided high-thoracic paravertebral block relieves referred pain caused by cervical spondylosis and provides stellate ganglion-blocking effect[J].J Clin Anesth,2016,34:490-491.
[25]KULHARI S,BHARTI N,BALA I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy:a randomized controlled trial[J].Br J Anaesth,2016,117(3):382-386.
[26]DIAZ A,LEDESMA B,GILSANZ F.Thoracic paravertebral block plus pectoral nerve block for mastectomy in a patient with advanced amyotrophic lateral sclerosis[J].Rev Esp Anestesiol Reanim,2014,61(3):172-173.
[27]GAUTAM S K S,DAS P K,AGARWAL A,et al.Comparative evaluation of continuous thoracic paravertebral block and thoracic epidural analgesia techniques for post-operative pain relief in patients undergoing open nephrectomy:a prospective,randomized,single-blind study[J].Anesth Essays Res,2017,11(2):359-364.