CAJ | 학술논문

目的评价胸腔镜肺癌根治术后病人自控椎旁神经阻滞(PCPB)对细胞免疫功能的优化程度.方法择期胸腔镜肺癌根治术病人41例,年龄50 ～ 64岁,BMI 20～25 kg/m2,ASA分级Ⅰ或Ⅱ级,TNM分期Ⅰ或Ⅱ期,性别不限,采用随机数字表法,将其分为2组:PCIA组(n=21)和PCPB组(n=20),PCIA组药液配方:舒芬太尼2μg/kg,生理盐水稀释至100 ml,背景输注速率2 ml/h,锁定时间15 min,PCA剂量2 ml;PCPB组术毕于患侧T5椎旁注射0.2％罗哌卡因5 ml,随后行PCPB,药液配方:0.75％罗哌卡因67 ml,生理盐水稀释至250 ml,背景输注速率5 ml/h,锁定时间15 min,PCA剂量5 ml,维持VAS评分≤3分,镇痛至术后50 h.分别于麻醉诱导前即刻(基础状态)、术毕、术后1、3、5d时采集静脉血样,检测调节性T细胞、自然杀伤细胞和自然杀伤T细胞的水平,并检测血浆白细胞介素-10和转化生长因子-β浓度.结果与PCIA组比较,PCPB组术后1、3d时调节性T细胞水平降低,自然杀伤细胞水平和自然杀伤T细胞水平升高,血浆白细胞介素-10及转化生长因子-β的浓度降低(P＜0.05或0.01),术后细胞免疫功能低下率差异无统计学意义(p＞0.05).结论胸腔镜肺癌根治术后PCPB对细胞免疫功能的优化程度无临床意义.
목적 평개흉강경폐암근치술후병인자공추방신경조체(PCPB)대세포면역공능적우화정도.방법 택기흉강경폐암근치술병인41례,년령50 ～ 64세,BMI 20～25 kg/m2,ASA분급Ⅰ혹Ⅱ급,TNM분기Ⅰ혹Ⅱ기,성별불한,채용수궤수자표법,장기분위2조:PCIA조(n=21)화PCPB조(n=20),PCIA조약액배방:서분태니2μg/kg,생리염수희석지100 ml,배경수주속솔2 ml/h,쇄정시간15 min,PCA제량2 ml;PCPB조술필우환측T5추방주사0.2％라고잡인5 ml,수후행PCPB,약액배방:0.75％라고잡인67 ml,생리염수희석지250 ml,배경수주속솔5 ml/h,쇄정시간15 min,PCA제량5 ml,유지VAS평분≤3분,진통지술후50 h.분별우마취유도전즉각(기출상태)、술필、술후1、3、5d시채집정맥혈양,검측조절성T세포、자연살상세포화자연살상T세포적수평,병검측혈장백세포개소-10화전화생장인자-β농도.결과 여PCIA조비교,PCPB조술후1、3d시조절성T세포수평강저,자연살상세포수평화자연살상T세포수평승고,혈장백세포개소-10급전화생장인자-β적농도강저(P＜0.05혹0.01),술후세포면역공능저하솔차이무통계학의의(p＞0.05).결론 흉강경폐암근치술후PCPB대세포면역공능적우화정도무림상의의.
Objective To evaluate the patient-controlled paravertebral block (PCPB) in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in patients.Methods Forty-one ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 50-64 yr,with body mass index of 20-25 kg/m2,of TNM staging Ⅰ or Ⅱ,undergoing radical resection of pulmonary carcinoma performed via video-assisted thoracoscope,were randomly divided into 2 groups using a random number table:PCIA group (n =21) and PCPB group (n =20).PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In PCPB group,the patients received paravertebral injection of 0.2％ ropivocaine 5 ml at T5 level on the affected side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0.75％ ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose,with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3,and analgesia lasted until 50 h after operation.Before induction of anesthesia (baseline),at end of operation,and at 1,3 and 5 days after operation,peripheral venous blood samples were collected to determine the levels of regulatory T cells,natural killer cells and natural killer T cells (by flow cytometry) and plasma concentrations of interleukin-10 and transforming growth factor-β (by ELISA).Results Compared with group PCIA,the level of regulatory T cells was significantly decreased,the levels of natural killer cells and natural killer T cells were increased,and the plasma concentrations of interleukin-10 and transforming growth factor-β were decreased at 1 and 3 days after operation,and no significant change was found in the rate of cellular immune function decline after operation in group PCPB.Conclusion PCPB provides no significant difference clinically in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in the patients.