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Received:December 04, 2022 Published Online:March 20, 2023
Received:December 04, 2022 Published Online:March 20, 2023
中文摘要: 目的 评估全麻联合超声引导神经阻滞(NB)镇痛技术对直肠癌根治术患者围术期免疫微环境的影响。方法 选择2017年10月至2018年4月常州市第一人民医院收治的60例直肠癌患者为研究对象,随机分为对照组[采取全身麻醉(GA) +静脉自控镇痛(PCIA)方案]和试验组(采取GA+PCIA+NB方案)。记录术中和术后阿片类药物的消耗。测量术前24 h、术中、术后6、12、24 h的自然杀伤细胞(NK)、CD4+、CD4+/CD8+细胞和白细胞介素(IL)-6水平。结果 两组术中至术后的舒芬太尼消耗呈显著升高趋势(P<0.01),且对照组比试验组每6 h 多消耗4.6 μg(P<0.01)。试验组的补救镇痛率显著低于对照组(16.7% vs 46.7%,P=0.012)。两组除IL-6在术前24 h至术中阶段有轻度升高,NK、CD4+、CD4+/CD8+细胞、IL-6四项指标总体均呈先抑制后恢复的趋势,且IL-6抑制持续最久,其次是NK细胞,而CD4+和CD4+/CD8+细胞恢复较早。比较CD4+和CD4+/CD8+细胞发现,对照组比试验组抑制持续的更久(P<0.05)。结论 超声引导NB技术能为直肠癌根治术患者减少术中及术后阿片类药物的消耗,并减轻免疫功能抑制。
Abstract:Objective To assess the effects of ultrasound-guided nerve block analgesia on immune microenvironment in patients with rectal cancer (RC) during perioperative period. Methods Sixty patients with rectal cancer were selected as the study subjects and randomly divided into two groups: control group [general anesthesia (GA)+patient-controlled intravenous analgesia (PCIA)scheme] and test group (GA+PCIA+NB scheme). The total dosage of opioids during and after operation was recorded. The levels of NK, CD4+, CD4+/CD8+cells and IL-6 were measured 24 hours before, during and 6, 12 and 24 hours after operation. Results The amount of sufentanil during and after operation in the two groups was significantly increased (P<0.01), and the amount of sufentanil in the control group was 4.6 μg more than that in the test group every 6 h (P<0.01)。 The remedial analgesia rate in test group was significantly lower than that in the control group (16.7% vs 46.7%, P=0.012). In the two groups, except for the slight increase of IL-6 in the 24 h before and during the operation, the four indexes of NK, CD4+, CD4+/CD8+ and IL-6 showed a trend of first inhibition and then recovery, and the inhibition of IL-6 lasted the longest, followed by NK cells, while CD4+and CD4+/CD8+cells recovered earlier. Comparing CD4+and CD4+/CD8+cells, it was found that the inhibition lasted longer in the control group than in the test group (P<0.05). Conclusion Ultrasound-guided NB technology can reduce the consumption of opioids during and after radical resection of rectal cancer, and reduce the inhibition of immune function.
keywords: Ultrasound guidance Nerve block Patient controlled intravenous analgesia Radical rectal cancer surgery Immune microenvironment
文章编号: 中图分类号:R735.3+7 R614.4 文献标志码:B
基金项目:常州市科学技术局应用基础研究计划项目(CJ20220098);常州市卫健委青年人才科技项目(QN202113)
Author Name | Affiliation |
MAO Gu*, QIU Lan | *Department of Anesthesiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210031, China |
仇澜2 | 2. 常州市第一人民医院麻醉科, 江苏 常州 213003 |
Author Name | Affiliation |
MAO Gu*, QIU Lan | *Department of Anesthesiology, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210031, China |
仇澜2 | 2. 常州市第一人民医院麻醉科, 江苏 常州 213003 |
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