标题：不同麻醉方法应用于腹腔镜肾癌根治术的麻醉效果和安全性研究

      作者：牛晶，张天庆    空军军医大学第二附属医院麻醉科，陕西 西安 710000

      卷次： 2023年34卷5期

      【摘要】 目的 比较低位前锯肌平面阻滞(SAPB) 联合全麻与腰方肌阻滞(QLB)联合全麻应用于腹腔镜肾癌根治术的的麻醉效果和安全性。方法 前瞻性选取2019年1月至2022年1月空军军医大学第二附属医院收治的98例肾癌患者作为研究对象，采用随机数表法分为A组和B组，每组49例。所有患者均接受腹腔镜肾癌根治术，A组接受SAPB联合全麻，B组接受QLB联合全麻。比较两组患者的阻滞操作时间、阻滞起效时间；比较两组患者麻醉前和麻醉后1 h、6 h的T细胞亚群(CD4+ T淋巴细胞和CD8+ T淋巴细胞)、免疫球蛋白(IgG、IgM)；比较两组患者的不良反应发生情况。结果 A组患者的阻滞操作时间和阻滞起效时间分别为(8.25±1.51) min、(7.68±1.42) min，明显短于B组的(14.98±1.47) min、(12.54±1.58) min，差异均有统计学意义(P<0.05)；A组和B组患者麻醉后 1 h血清CD4+ T淋巴细胞分别为(40.65±2.41)%和(40.43±1.53)%，麻醉后 6 h血清CD4+ T淋巴细胞分别为(42.31±1.17)%和(42.53±1.24)%，明显低于本组麻醉前的(45.15±2.59)%和(45.24±2.62)%，差异均有统计学意义(P<0.05)；A组和B组患者麻醉后1 h血清CD8+ T淋巴细胞分别为(24.52±1.21)%和(24.69±1.41)%，麻醉后6 h血CD8+ T淋巴细胞分别为(24.87±1.32)%和(24.75±1.28)%，明显高于麻醉前的(23.54±2.18)%和(23.66±2.20)%，差异均有统计学意义(P<0.05)；与麻醉后1 h比较，两组患者麻醉后6 h血清CD4+ T淋巴细胞水平均明显升高，差异有统计学意义(P<0.05)；两组患者麻醉后1 h的血清 IgM 、IgG均明显低于其麻醉前和麻醉后6 h的血清 IgM 、IgG，差异均有统计学意义(P<0.05)；A组与B组患者的不良反应发生率分别为6.12% (3/49)、8.16% (4/49)，差异无统计学意义(P>0.05)。结论 SAPB联合全麻与QLB联合全麻均可安全运用在腹腔镜肾癌根治术中，对患者术后机体免疫功能影响较低，但相比于QLB联合全麻，SAPB联合全麻阻滞时间和阻滞起效时间更短，且操作更简便。
      【关键词】 SAPB；QLB；全麻；腹腔镜肾癌根治术；肾癌
      【中图分类号】 R614 【文献标识码】 A 【文章编号】 1003—6350（2023）05—0655—04

Anesthetic effect and safety of different anesthesia methods for laparoscopic radical nephrectomy.
NIU Jing,ZHANG Tian-qing. Department of Anesthesiology, the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To compare the anesthetic effect and safety of serratus anterior plane block (SAPB) orquadratus lumborum block (QLB) combined with general anesthesia for laparoscopic radical nephrectomy. Methods Atotal of 98 patients with renal cell carcinoma admitted to the Second Affiliated Hospital of Air Force Medical Universityfrom January 2019 to January 2022 were selected as research objects. The patients were divided into group A and groupB according to random number table method, with 49 patients in each group. All patients received laparoscopic radicalresection for renal cancer. The patients in the group A received SAPB combined with general anesthesia, and the patientsin the group B received QLB combined with general anesthesia. The duration of block operation and block onset timewere compared between the two groups. T cell subsets (CD4+ T lymphocytes and CD8+ T lymphocytes) and immunoglob-ulin (IgG, IgM) before anesthesia and at 1 h, 6 h after anesthesia were compared between the two groups. The occur-rence of adverse reactions was compared between the two groups. Results The duration of block operation and block on-set time were (8.25±1.51) min and (7.68±1.42) min in the group A, which were significantly shorter than (14.98±1.47) minand (12.54±1.58) min in the group B (P<0.05). Serum CD4+ T lymphocytes levels were (40.65±2.41)% in group A and(40.43±1.53)% in group B at 1 h after anesthesia, and (42.31±1.17)% in group A and (42.53±1.24)% in group B at 6 h af-ter anesthesia, which were significantly lower than (45.15±2.59)% and (45.24±2.62)% before anesthesia (P<0.05). Se-rum CD8+ T lymphocytes levels in the group A and group B were (24.52±1.21)% and (24.69±1.41)% at 1 h after anesthe-sia, and (24.87±1.32)% and (24.75±1.28)% at 6 h after anesthesia, which were higher than (23.54±2.18)% and (23.66±2.20)% before anesthesia (P<0.05). Compared with 1 h after anesthesia, the levels of serum CD4+ T lymphocytes in thetwo groups were significantly increased at 6 h after anesthesia (P<0.05). Serum levels of IgM and IgG at 1 h after anes-thesia were significantly lower than those before anesthesia and at 6 h after anesthesia (P<0.05). The adverse reactionrate was 6.12% (3/49) in group A and 8.16% (4/49) in group B, with no statistically significant difference (P>0.05).Conclusion General anesthesia combined with SAPB or QLB are safe in laparoscopic radical nephrectomy, which hasa low impact on the immune function of patients after surgery. However, SAPB combined with general anesthesia hasthe advantages of shorter block time and block onset time, and simpler operation, compared with QLB combined withgeneral anesthesia.
      【Key words】 Serratus anterior plane block; Quadratus lumborum block; General anesthesia; Laparoscopic radicalnephrectomy; Renal cell carcinoma