胸椎旁神经阻滞与硬膜外麻醉对非气管插管肺叶切除术患者镇痛和免疫的影响*

Comparison of thoracic paravertebral block versus epidural block on analgesia and immunity in patients undergoing non-intubated lobectomy*

摘要:

目的?比较胸椎旁神经阻滞（TPVB）和硬膜外阻滞（EB）对非气管插管肺叶切除术患者镇痛和免疫的影响。方法?选取2019年1月—2019年6月在青岛大学附属青岛市市立医院东院区行胸腔镜下肺叶切除术的120例非小细胞肺癌患者，用随机数字表法分为TPVB组、EB组和全身麻醉（GA）组。比较各组患者围手术期镇痛和芬太尼追加量情况、细胞免疫及体液免疫水平。结果?3组术后1?h、2?h、6?h、12?h、24?h和48?h VAS评分在不同时间、不同组间及变化趋势上有差异（P?<0.05）。3组芬太尼追加量比较，差异有统计学意义（P?<0.05），GA组高于TPVB组、EB组（P?<0.05）。3组术后第1天和第3天CD3+CD4+、CD3+CD8+水平在不同时间、不同组间有差异（P?<0.05），变化趋势无差异（P?>0.05）。3组术后第1天和第3天CD3-CD16+CD56+、CD19+水平在不同时间、不同组间及变化趋势上无差异（P?>0.05）。3组术后第1天和第3天IgG、IgM、IgA在不同时间有差异（P?<0.05），不同组间及变化趋势上无差异（P?>0.05）。与EB组比较，TPVB组患者围手术期低血压发生率降低（P?<0.05）。结论?对于非气管插管肺叶切除术患者，TPVB和EB均能提供有效的围手术期镇痛；同时TPVB术后镇痛时间更持久，术后T淋巴细胞免疫抑制减轻。

Abstract:

Objective To compared the effect of thoracic paravertebral block versus epidural block on analgesia and immunity in patients undergoing non-intubated video-assisted thoracoscopic (VATS) lobectomy. Methods A total of 120 patients who underwent non-intubated VATS lobectomy were recruited, with the age between 35 and 68 years, BMI between 20.5 and 25.8 kg/m2, falling into ASA physical status I or II. The patients were randomly divided into thoracic paravertebral block (TPB) group, thoracic epidural block (TEB) group and general anesthesia (GA) group by random number table method, with each group of 40 participants. Additional information on fentanyl, VAS score, cellular and humoral immune function among these three groups were compared. Results Compared with TEB group, VAS score at 48 h after surgery in TPB group were significantly decreased (P??0.05). However, VAS score at 1 h, 2 h, 6 h, 12 h, 24 h and 48 h after surgery in TPB and TEB group was both lower than that in the GA group (P??0.05). Incidence of hypotension in TPB group was lower than that in TEB group (P?