标题：胸椎旁神经阻滞联合腰方肌阻滞对腹腔镜肾脏手术患者免疫功能和炎症状态的影响

      作者：牛江涛，喻倩，陶蕾，杨永慧，卫白杨，殷俊茹    中国人民解放军空军军医大学第二附属医院麻醉科，陕西 西安 710038

      卷次： 2022年33卷9期

      【摘要】 目的 探讨胸椎旁神经阻滞(TPVB)联合腰方肌阻滞(QLB)对腹腔镜肾脏手术患者免疫功能和炎症状态的影响。方法 选取2019年6月至2021年6月中国人民解放军空军军医大学第二附属医院收治的择期行腹腔镜肾脏手术患者184例为研究对象，采用随机数表法将患者分为观察组和对照组，每组92例。两组患者均行腹腔镜肾脏手术治疗，在麻醉诱导前，对照组采用TPVB麻醉，观察组采用TPVB联合QLB麻醉，两组均行静吸复合全麻维持麻醉，术毕行静脉自控镇痛。比较两组患者术后镇痛泵按压次数、镇痛泵药物用量情况，术后48 h内的疼痛视觉模拟评分(VAS)，围手术期的收缩压、平均动脉压和心率情况，术前 1 d、术后 2 d的血清超敏C-反应蛋白(hs-CRP)、白介素6 (IL-6)、肿瘤坏死因子-α (TNF-α)水平和T淋巴细胞亚群变化情况。结果 观察组患者术后镇痛泵有效按压次数(4.82±1.05)次、镇痛泵总按压次数(8.37±2.13)次和镇痛泵药物用量(9.25±2.43) μg，明显少(低)于对照组的(7.91±1.14)次、(12.56±2.49)次和(20.29±4.51) μg，差异均有统计学意义(P<0.05)；观察组患者术后1 h、6 h、12 h、24 h、48 h的VAS评分分别为(3.24±0.97)分、(3.63±1.19)分、(3.08±0.72)分、(2.76±0.52)分、(1.56±0.42)分，明显低于对照组的(4.13±1.05)分、(4.45±1.22)分、(3.74±1.04)分、(3.17±1.10)分、(2.17±0.56)分，差异均具有统计学意义(P<0.05)；观察组患者在手术开始后30 min和1 h的收缩压和平均动脉压明显低于对照组，心率明显快于对照组，差异均具有统计学意义(P<0.05)；术后 2 d，观察组患者血清 hs-CRP、IL-6和 TNF-α水平分别为(19.85±2.27) ng/L、(3.69±1.26) mg/L、(22.25±2.98) ng/L，明显低于对照组的(23.64±2.49) ng/L、(4.73±1.52) mg/L、(25.41±2.69) ng/L，CD3+、CD4+和 CD4+/CD8+细胞比例分别为(62.71±5.62)%、(38.38±3.45)%、1.52±0.31，明显高于对照组的(59.58±5.74)%、(35.13±3.26)%、1.38±0.34，差异均有统计学意义(P<0.05)。结论 TPVB联合QLB应用于腹腔镜肾脏手术患者中可发挥较好的镇痛效果，减轻患者术后炎症状态，并改善细胞免疫功能。
      【关键词】 腹腔镜肾脏手术；胸椎旁神经阻滞；腰方肌阻滞；炎症状态；免疫功能
      【中图分类号】 R699.2 【文献标识码】 A 【文章编号】 1003—6350（2022）09—1103—05

Effects of thoracic paravertebral block combined with quadratus lumborum block on immune function andinflammatory status in patients undergoing laparoscopic renal surgery.
NIU Jiang-tao, YU Qian, TAO Lei, YANGYong-hui, WEI Bai-yang, YIN Jun-ru. Department of Anesthesiology, the Second Affiliated Hospital of Air Force MilitaryMedical University of Chinese People's Liberation Army, Xi'an 710038, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of thoracic paravertebral block (TPVB) combined with quadratuslumborum block (QLB) on immune function and inflammatory status in patients treated with laparoscopic renal surgery.Methods A total of 184 patients scheduled for laparoscopic renal surgery in the Second Affiliated Hospital of Air ForceMilitary Medical University, Chinese People's Liberation Army, were enrolled as the research objects between June 2019and June 2021. According to random number table method, they were divided into an observation group and a controlgroup, with 92 cases in each group. Both groups underwent laparoscopic renal surgery. Before anesthesia induction, pa-tients in the control group underwent TPVB anesthesia, while those in the observation group underwent TPVB combinedwith QLB for anesthesia. Both groups underwent intravenous inhalation combined with general anesthesia for anesthesiamaintenance, and patient-controlled intravenous analgesia was conducted after surgery. The presses times of analgesicpump, dosage of analgesic pump drug, Visual Analogue Scale (VAS) scores within 48 h after surgery, perioperative sys-tolic blood pressure, mean arterial pressure, heart rate, changes in levels of serum high-sensitivity C-reactive protein(hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and T lymphocyte subsets at 1 d before surgery and 2 dafter surgery were compared between the two groups. Results The effective presses times and total presses times of an-algesic pump, and dosage of analgesic pump drug in the observation group were (4.82±1.05) times, (8.37±2.13) times,and (9.25±2.43) μg, significantly fewer (lower) than (7.91±1.14) times, (12.56±2.49) times, (20.29±4.51) μg in the con-trol group (P<0.05). At 1 h, 6 h, 12 h, 24 h, and 48 h after surgery, VAS scores in the observation group were (3.24±