摘要
目的:探讨盐酸右美托咪定联合盐酸罗哌卡因胸椎旁神经阻滞(TPVB)对肺癌根治术患者血清炎性因子和免疫学指标的影响。方法:选取2018年4月~2020年4月期间于我院行肺癌根治术的患者400例,根据信封抽签法分为对照组和观察组,各200例,对照组给予盐酸罗哌卡因TPVB,观察组在对照组基础上联合盐酸右美托咪定,对比两组疼痛、炎性因子、免疫学指标、血流动力学及不良反应。结果:观察组术后6 h(T5)~术后48h(T8)时间点视觉模拟评分法(VAS)评分均低于对照组(P<0.05)。对照组插管后5 min(T1)~术毕(T3)时间点心率(HR)及平均动脉压(MAP)较麻醉诱导前(T0)时间点升高(P<0.013),观察组T1~T3时间点HR、MAP低于对照组(P<0.05)。两组T8时间点白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)均较T0下降,且观察组低于对照组(P<0.05)。两组T8时间点CD4^(+)、CD4^(+)/CD8^(+)均较T0时间点下降,但观察组高于对照组(P<0.05),CD8^(+)均较T0时间点升高,但观察组低于对照组(P<0.05)。观察组不良反应总发生率低于对照组(P<0.05)。结论:盐酸右美托咪定联合盐酸罗哌卡因TPVB用于肺癌根治术患者,可稳定血流动力学,且可获得较好的镇痛效果,降低不良反应发生率,减轻术后炎性损伤及免疫抑制。
Objective:To investigate the effects of thoracic paravertebral nerve block(TPVB)with dexmedetomidine hydrochloride and ropivacaine hydrochloride on serum inflammatory factors and immunological indexes in patients with lung cancer undergoing radical resection.Methods:400 patients with radical resection of lung cancer who were admitted in our hospital from April2018 to April 2020 were selected,they were randomly divided into control group and observation group,200 cases in each group,the control group was given ropivacaine hydrochloride TPVB,while the observation group was treated with dexmedetomidine hydrochloride on the basis of the control group,pain,inflammatory factors,immunological indexes,hemodynamics and adverse reactions of the two groups were compared.Results:The visual analogue scoring(VAS)score of the observation group was lower than that of the control group at the time point of 6 h after operation(T5)~48 h after operation(T8)(P<0.05).Heart rate(HR)and mean arterial pressure(MAP)at the time point of 5 min after intubation(T1)~end of operation(T3)in the control group were higher than the time point of before anesthesia induction(T0)(P<0.013),while HR,MAP at the time point of T1-T3 in the observation group were lower than those of the control group(P<0.05).The interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)at the time point of T8 were lower than T0,and the observation group was lower than the control group(P<0.05).The CD4^(+),CD4^(+)/CD8^(+)at the time point of T8 were lower than T0,but the observation group was higher than the control group(P<0.05),CD8^(+)was higher than T0,but the observation group was lower than the control group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that of the control group(P<0.05).Conclusion:Dexmedetomidine hydrochloride combined with ropivacaine hydrochloride TPVB for patients with radical resection of lung cancer,has exact analgesic effect,can maintain the stability of hemodynamics,reduce the incidence of postoperative inflammatory injury and incidence of adverse reactions,and reduce the immunosuppression.
作者
戴长宗
邓建冬
刘伊玲
刘玲
谭磊
DAI Chang-zong;DENG Jian-dong;LIU Yi-ling;LIU Ling;TAN Lei(Department of Anesthesiology,Changsha First Hospital,Changsha,Hunan,410005,China;Department of Surgery,The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha,Hunan,410005,China)
出处
《现代生物医学进展》
CAS
2021年第15期2991-2995,2952,共6页
Progress in Modern Biomedicine
基金
湖南省自然科学基金面上项目(2017JJ2285)。
关键词
盐酸右美托咪定
盐酸罗哌卡因
胸椎旁神经阻滞
肺癌根治术
炎性因子
免疫学指标
Dexmedetomidine hydrochloride
Ropivacaine hydrochloride
Thoracic paraspinal nerve block
Radical resection of lung cancer
Inflammatory factors
Immunological indicators
作者简介
戴长宗(1978-),女,硕士,主治医师,研究方向:临床麻醉,E-mail:xbfiuy@163.com;通讯作者:谭磊(1983-),女,硕士,研究方向:肺癌及其预后,E-mail:tl13508489231@163.com。
