摘要
目的探讨超声引导下胸椎旁神经阻滞(TPVB)或胸段硬膜外阻滞(TEA)复合全麻对肺癌根治术患者炎性反应的影响。方法择期肺癌根治术患者45例,年龄42～65岁,体重55～82kg,ASAⅠ或Ⅱ级,随机分为胸椎旁神经阻滞复合全麻组(PG组)、硬膜外阻滞复合全麻组(EG组)和单纯全麻组(GA组)。PG组在超声引导下行TPVB(T4～5);EG组硬膜外穿刺置管(T4～5)。分别于麻醉前(T0)、手术开始30min(T1)、术毕(T2)、术后6h(T3)时采集静脉血样,测定白细胞介素(IL)-6和IL-10浓度,同时观察MAP、HR的变化。结果与T0时比较,T2、T3时三组患者血清IL-6、IL-10浓度明显升高(P<0.05);T1时PG组和EG组MAP明显降低、GA组MAP明显升高(P<0.05);而EG组HR明显减慢(P<0.05)。与GA组比较,T2、T3时PG组和EG组血清IL-6浓度明显降低、IL-10浓度明显升高(P<0.05);T1、T2时PG组和EG组MAP明显降低、T2时PG组和EG组HR明显减慢(P<0.05)。结论椎旁神经阻滞或硬膜外阻滞可以减轻肺癌根治术患者炎性反应,胸椎旁神经阻滞较硬膜外阻滞血流动力学稳定。
Objective To investigate inflammatory reaction and hemodynamics in patients undergoing radical resection for lung cancer under ultrasound-guided thoracic paravertebral block （TPVB） or thoracic epidural block（TEA） combined with general anesthesia. Methods Forty-five ASA I or Ⅱ patients aged 42-65 years old, weighting 55 82 kg, undergoing radical resection for lung cancer, were randomly divided into 3 groups（n = 15 each）： TPVB combined with general anesthesia group （group PC＋）, TEA combined with general anesthesia（group EG）and pure general anesthesia group（group GA）. TPVB （T4-5 ） guided by ultrasound was applied on group PG patients; Epidural block （T4-5） was applied on group EG. Blood samples via internal jugular at preanesthesia （To）, 30 min after surgery started（T1 ）, surgey finish （T2） and 6h postoperative （T3）. Serum interleukin-6（IL-6） and IL-10 were determined by ELISA. MAP and HR was recorded at each time. Results Compared with To, serum IL-6 and IL-10 concentrations were higher at T2 and T3 in three groups （P〈0. 05）. Compared with group GA, serum IL-6 concentration were lower at T2 and T3 in PG and group EG （P〈0. 05）. Serum IL-10 concentration were higher at T2 and T3 in group PG and EG （P〈0.05） ; There was no significant difference of serum IL-6 and IL-10 between PG and EG group at T2 ,T3. Compared with group GA,MAP and HR were reduced at T1 in group PG and EG （P 〈0. 05）. And compared with group PG, MAP and HR were reduced at T1 in group EG（P〈0.05）. Conclusion TPVB or TEA can reduce inflammatory reaction in patients undergoing radical resection for lung cancer, TPVB can remain hemodynamics stable compared with TEA.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第5期472-474,共3页
Journal of Clinical Anesthesiology
