文章摘要
超声引导下前锯肌平面阻滞对开腹肝癌切除术围术期细胞免疫功能的影响
Effects of perioperative cellular immune function of ultrasound-guided serratus anterior plane block in patients undergoing radical operation of hepatic carcinoma
  
DOI：10.12089/jca.2019.09.004
中文关键词: 超声引导  前锯肌平面阻滞  开腹手术  肝癌  细胞免疫
英文关键词: Ultrasound guided  Serratus anterior plane block  Laparotomy  Hepatic carcinoma  Cellular immune
基金项目:
作者单位E-mail
施志波 362000,福建省泉州市,解放军联勤保障部队第九一〇医院麻醉科  
许福生 362000,福建省泉州市,解放军联勤保障部队第九一〇医院麻醉科  
吴志云 362000,福建省泉州市,解放军联勤保障部队第九一〇医院麻醉科  
査本俊 362000,福建省泉州市,解放军联勤保障部队第九一〇医院麻醉科  
庄海滨 362000,福建省泉州市,解放军联勤保障部队第九一〇医院麻醉科 906571075@qq.com 
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中文摘要:
      
目的 探讨超声引导下前锯肌平面阻滞(serratus anterior plane block, SAPB)对经肋缘下开腹肝癌切除术患者围术期细胞免疫功能的影响。
方法 开腹肝癌切除术患者55例,男33例,女22例,年龄48～65岁,体重57～72 kg,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组:SAPB联合全麻组(S组,n=28)和单纯全麻组(D组,n=27)。S组患者于全麻诱导后行超声引导下右侧第8—11肋SAPB,将0.5％罗哌卡因5 ml从第8—11逐肋分别注入。D组诱导后于相同位置注射等量生理盐水。术中采用七氟醚吸入和瑞芬太尼静脉泵注维持麻醉,术中根据需要追加舒芬太尼,术后均行舒芬太尼PCIA。记录术中瑞芬太尼、舒芬太尼用量,术后0～24 h和0～48 h镇痛泵按压次数,分别在诱导时、术后1 h、24 h和48 h检测外周血干扰素γ(INF-γ)和IL-4的浓度,计算INF-γ/IL-4比值。
结果 与D组比较,S组术中瑞芬太尼［(1.92±0.47) mg vs (2.33±0.38)mg, P<0.05］和舒芬太尼追加次数明显减少,术后0～24 h和0～48 h镇痛泵按压次数明显减少(P<0.05),术后INF-γ浓度［1 h: (5.42±0.80)pg/ml vs (4.11±0.79)pg/ml, 24 h: (4.23±0.90)pg/ml vs (3.88±0.62)pg/ml, 48 h: (4.42±0.85)pg/ml vs (3.79±0.83)pg/ml, P均<0.05］和INF-γ/IL-4比值明显升高(1 h: 2.19±0.44 vs 1.62±0.71, 24 h: 1.67±0.48 vs 1.35±0.42, 48 h: 1.77±0.63 vs 1.58±0.60, P均<0.05)。
结论 超声引导下前锯肌阻滞可能有助于减轻肋缘下开腹肝癌切除术患者围术期的免疫抑制反应。
英文摘要:
      
Objective To investigate the perioperative cellular immune function of ultrasound-guided serratus anterior plane block (SAPB) in patients undergoing radical operation of hepatic carcinoma.
Methods Fifty-five patients, 33 males and 22 females, aged 48-65 years, weighing 57-72 kg, falling into ASA physical status Ⅰ or Ⅱ,who underwent laparotomy operation of hepatic carcinoma, were randomly divided into two groups: SAPB combined general anesthesia group (group S, n = 28) and simple general anesthesia group (group D, n = 27). Group S received SAPB from the 8th to the 11th rib on the right with 0.5％ ropivacaine 5 ml after anesthesia induction. Group D was injected with the same amount of normal saline at the same place after induction. Sevoflurane inhalation and remifentanil intravenous pump were used to maintain anesthesia during operation. Postoperative PCIA was performed in all patients.Dosage of remifentanil and sufentanil during operation, and the number of self-controlled pressing for patients within 24 h and 48 h analgesic pump after operation were recorded. Concentrations of interferon-γ (INF-γ) and interleukin-4 (IL-4) in peripheral blood before the induction of anesthesia, at 1 h after the end of the surgery, 24 h after the surgery and 48 h after the surgery were measured,and INF-γ/IL-4 ratio was calculated.
Results Combined with group D,the dosage of remifentanil (1.92 ± 0.47 mg vs 2.33 ± 0.38 mg, P < 0.05) and the number of addition of sufentanil decreased significantly in group S, the pressing times of analgesic pump within 24 and 48 hours after operation were significantly less in group S (P < 0.05),the concentration of INF-γ (1 h: 5.42 ± 0.80 pg/ml vs 4.11 ± 0.79 pg/ml, 24 h: 4.23 ± 0.90 pg/ml vs 3.88 ± 0.62 pg/ml, 48 h: 4.42 ± 0.85 pg/ml vs 3.79 ± 0.83 pg/ml, all P < 0.05) and the ratio of INF-γ/IL-4 (1 h: 2.19 ± 0.44 vs 1.62 ± 0.71, 24 h: 1.67 ± 0.48 vs 1.35 ± 0.42, 48 h: 1.77 ± 0.63 vs 1.58 ± 0.60, all P < 0.05) in group S increased significantly.
Conclusion Ultrasound-guided anterior serratus block may be helpful to alleviate the perioperative immune suppressive response in patients undergoing radical resection of hepatic carcinoma.
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