摘要
目的探讨超声引导下Ⅱ型胸神经阻滞对全麻下行乳腺癌手术患者免疫功能的影响。方法择期行乳腺癌手术治疗患者196例随机分为单纯全麻组(G组)和全麻辅合超声引导下Ⅱ型胸神经阻滞组(PG组),每组98例。所有患者均接受利多卡因、异丙酚和瑞芬太尼的麻醉诱导和维持。调整瑞芬太尼剂量以使术中BIS值保持在40~60。采用靶控输注(TCI)泵,分别使用Schnider和Minto的药代动力学模型来计算丙泊酚和瑞芬太尼用量。PG组全麻诱导后给予超声引导下Ⅱ型胸神经阻滞。术中监测心电图、无创血压、脉搏血氧饱和度、体温、双谱指数当双谱指数>60时,给予异丙酚0.5μg/kg(间隔为1 min或更长时间)静脉注射。当心率降至50次/min以下时,静脉注射阿托品0.5 mg。术后24 h,将患者的血液样本收集在肝素管中以进行NK细胞分离、凋亡分析、细胞毒性分析。结果发现PG组的瑞芬太尼消耗量少于G组(P<0.05)。术后PG组外周血单核细胞(PBMC)中NK细胞比例和杀伤活性高于G组(P<0.05)。存在NK细胞的情况下,G组患者血清与正常血清比较,显著促进乳腺癌细胞凋亡(P<0.05)。2组术后血清培养的乳腺癌细胞凋亡率均明显低于术前(P<0.05)。但与PG组术后血清相比,G组术后血清明显抑制乳腺癌细胞凋亡率(P<0.05)。结论与单纯全身麻醉相比,Pecs-Ⅱ阻滞对患者的免疫功能有增强作用。
Objective To investigate effects of typeⅡpectoral nerve(Pecs)block guided by ultrasound under general anesthesia on the immune function of patients undergoing breast cancer operation.Methods A total of 196 patients with breast cancer who were ready to receive surgical treatment were enrolled in the study,who were randomly divided into simple general anesthesia group(group G)and typeⅡPecs block under general anesthesia group(PG group),with 98 cases in each group.The ECG,non-invasive blood pressure,blood oxygen saturation,body temperature during the operation were observed,and the activity of natural killing cells as well as the apoptosis rate of breast cancer cells were observed and compared between the two groups.Results The remifentanil consumption amount in PG group was significantly less than that in group G(P<0.05).After surgery,the proportion of NK cells in peripheral blood mononuclear cell(PBMC)and killing activity in PG group were significantly higher than those in group G(P<0.05).In the condition of NK cells,the seum in group G could significantly promote the apoptosis of breast cancer cells(P<0.05).After the breast cancer cells were cultured in vitro,the apoptosis rates of breast cancer cells in both groups were significantly lower than those before operation(P<0.05).As compared with the serum in PG group after operation,the serum in group G could significantly decrease the the apoptosis rate of breast cancer cells(P<0.05).higher than those in group G(P<0.05).Conclusion As compared with simple general anesthesia,the typeⅡPecs block can enhance the immunity function of patients.
作者
崔秀玲
刘萍
赵晓琛
于丽丽
赵浩晨
缴宝杰
CUI Xiuling;LIU Ping;ZHAO Xiaochen(Department of Anesthesiology,Cangzhou Central Hospital,Hebei,Cangzhou 061001,China)
出处
《河北医药》
CAS
2021年第6期837-841,共5页
Hebei Medical Journal
