超声下腹横肌阻滞对结肠腺癌根治围手术期细胞免疫功能的影响
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摘要
目的探讨超声引导下腹横肌平面(TAP)阻滞对腹腔镜下结肠腺癌根治术患者围手术期细胞免疫功能的影响。方法腹腔镜行结肠腺癌根治术患者70例。年龄50～70岁,体质量50～75 kg,ASAI～II级,采用随机数字表法分为两组,TAP阻滞复合全麻组(T组,n=35)和单纯全麻组(N组,n=35),两组患者于全麻诱导后行超声引导下TAP阻滞,分别注射20 mL 0.5%罗哌卡因(T组)或等量生理盐水(N组),术毕均采用病人自控镇痛(PCIA),比较两组诱导前(T0)、切皮前即刻(T1)、切皮后即刻(T2),手术开始1 h(T3)、手术开始2 h(T4)血压、心率,术中阿片类药物的用量,术后24 h、术后48 h镇痛泵按压的次数,术后1 h(T5)、术后第1天清晨(T6)、术后第3天清晨(T7)静息及咳嗽时VAS评分,并检测两组患者外周血T0、T5、T6、T7时刻白介素4(IL-4)、干扰素γ(INF-γ)的定量水平,求出INF-γ/IL-4比值。结果与N组比较,T组切皮时收缩压、舒张压、心率变化明显减小(P <0.05),术中阿片类药物的用量减少(P <0.05),术后24、48 h镇痛泵按压次数减少(P <0.05)。与N组比较,T组T5、T6静息及咳嗽时VAS评分均减少(P <0.05)。T组T5、T6、T7时刻INF-γ水平及INF-γ/IL-4比值明显高于N组(P <0.05)。结论超声引导下TAP阻滞减轻结肠腺癌根治术患者围术期免疫抑制。
Objective To investigate the effects of perioperative cellular immune function of ultrasound guided transversus abdominis plane(TAP)block in patients undergoing laparoscopic radical operation of colonic adenocarcinoma.Methods Accordingtotherandomnumbertable,70 patients(age50～70 years,weight50～70 kg,ASA grade Ⅰ or Ⅱ)were randomly divided into two groups:transversus abdominis plane block group(groupT,n = 35)and general anesthesia group(group N,n = 35). Group T received TAP block with 20 mL 0.5% ropivacaine after induction,while group N received equal normal saline. The blood pressure and heart rate were recorded before the induction of anesthesia(T0),the moment before the skin incision(T1),the moment after the skin incision(T2),1 hour after the start of surgery(T3),2 hour after the start of surgery(T4).The consumption of analgesic drug during the surgery and the number of times the pain pump presses were recorded within the 24 h and 48 h after the surgery. Meanwhile,the VAS scores at 1 hour after the end of the surgery(T5),the first morning after the surgery(T6),the third morning after the surgery(T7)were obtained. Venous blood samples were obtained at T0,T5,T6,T7.Recorded the value of plasma IL-4,INF-γand calculat the ratio of INF-γ/IL-4. Results Compared with group N,the changes of the systolic presses,diastolic presses and heart rate were significantly reduced in the T group(P <0.05). Meanwhile,the consumption of analgesic drug during the surgery were reduced(P < 0.05),the number of times the pain pump presses was less within the 24 h and 48 h after the surgery(P < 0.05). Combined with group N,the VAS scores at T5 and T6 in group T were significantly decreased when rest and cough(P < 0.05). Meanwhile,the INF-γ level and INF-γ/IL-4 ratio of T5,T6 and T7 were increased(P < 0.05). Conclusion Ultrasound guided TAP block can alleviate perioperative immuno-suppression in patients undergoing radical resection of colonic adenocarcinoma.
Objective To investigate the effects of perioperative cellular immune function of ultrasound guided transversus abdominis plane(TAP)block in patients undergoing laparoscopic radical operation of colonic adenocarcinoma.Methods Accordingtotherandomnumbertable,70 patients(age50～70 years,weight50～70 kg,ASA grade Ⅰ or Ⅱ)were randomly divided into two groups:transversus abdominis plane block group(groupT,n = 35)and general anesthesia group(group N,n = 35). Group T received TAP block with 20 mL 0.5% ropivacaine after induction,while group N received equal normal saline. The blood pressure and heart rate were recorded before the induction of anesthesia(T0),the moment before the skin incision(T1),the moment after the skin incision(T2),1 hour after the start of surgery(T3),2 hour after the start of surgery(T4).The consumption of analgesic drug during the surgery and the number of times the pain pump presses were recorded within the 24 h and 48 h after the surgery. Meanwhile,the VAS scores at 1 hour after the end of the surgery(T5),the first morning after the surgery(T6),the third morning after the surgery(T7)were obtained. Venous blood samples were obtained at T0,T5,T6,T7.Recorded the value of plasma IL-4,INF-γand calculat the ratio of INF-γ/IL-4. Results Compared with group N,the changes of the systolic presses,diastolic presses and heart rate were significantly reduced in the T group(P <0.05). Meanwhile,the consumption of analgesic drug during the surgery were reduced(P < 0.05),the number of times the pain pump presses was less within the 24 h and 48 h after the surgery(P < 0.05). Combined with group N,the VAS scores at T5 and T6 in group T were significantly decreased when rest and cough(P < 0.05). Meanwhile,the INF-γ level and INF-γ/IL-4 ratio of T5,T6 and T7 were increased(P < 0.05). Conclusion Ultrasound guided TAP block can alleviate perioperative immuno-suppression in patients undergoing radical resection of colonic adenocarcinoma.
引文
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[10]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[11]ROMAGNANI S.The Th1/Th2 paradigm[J].Immunol Today,1997,18(6):263-274.
[12]KIM R.Anesthetic technique and cancer recurrence in oncologic surgery:unraveling the puzzle[J].Cancer Metastasis Rev,2017,36(1):159-177.
[13]KIM R.Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence[J].J Transl Med,2018,16(1):8.
[14]CHEN W K,REN L,WEI Y,et al.Generalanesthesiacombined with epidural anesthesiaameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.2019-02-27
[2]BAKI B,MASCHA E,MORIARTY D C,et al.Anesthetic technique for radical prostatectomy surgery affects cancer recurrence:a retrospective analysis[J].Anesthesiology,2008,109(2):180-187.
[3]秦朝生,柳元铭,刘敬臣.腹横肌平面阻滞的临床应用进展[J].临床麻醉学杂志,2016,32(7):713-716.
[4]陈红芽,徐铭军.腹横肌平面阻滞在腹部手术术后镇痛中的应用[J].国际麻醉学与复苏杂志,2014,35(7):646-650.
[5]ALMARAKBI W A,KAKI A M.Addition of dexmedetomidine to bupivacaine in transversus abdominis plane block potentiates post-operative pain relief among abdominal hysterectomy patients:A prospective randomized controlled trial[J].Saudi J Anaesth,2014,8(2):161-166.
[6]乔迎帅,卢锡华.超声引导腹横肌平面阻滞用于下腹部手术患者术后镇痛效果的观察[J].实用医学杂志,2015,31(7):1137-1139.
[7]GRIFFITHS J D,BARRON F A,GRANT S,et al.Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block[J].Br J Anaesth,2010,105(6):853-856.
[8]LIU L,XIE Y H,ZHANG W,et al.Effect of transversus abdominis plane block on postoperative pain after colorectal surgery:a meta-analysis of randomized controlled trials[J].Med Princ Pract,2018,27(2):158-165.
[9]WU Y,LIU F,TANG H,et al.The analgesic efficacy of subcostal transversus abdominis plane block compared with thoracic epidural analgesia and intravenous opioid analgesia after radical gastrectomy[J].Anesth Analg,2013,117(2):507-513.
[10]董盛龙,朱少飞,林赛娟,等.超声引导腹横肌平面阻滞对结肠癌开腹手术患者循环应激及术后镇痛的影响[J].实用医学杂志,2017,33(2):259-262.
[11]ROMAGNANI S.The Th1/Th2 paradigm[J].Immunol Today,1997,18(6):263-274.
[12]KIM R.Anesthetic technique and cancer recurrence in oncologic surgery:unraveling the puzzle[J].Cancer Metastasis Rev,2017,36(1):159-177.
[13]KIM R.Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence[J].J Transl Med,2018,16(1):8.
[14]CHEN W K,REN L,WEI Y,et al.Generalanesthesiacombined with epidural anesthesiaameliorates the effect of fast-track surgery by mitigating immunosuppression and facilitating intestinal functional recovery in colon cancer patients[J].Int J Colorectal Dis,2015,30(4):475-481.2019-02-27