文章摘要
不同麻醉方法对开胸食管癌根治术患者围术期免疫功能和远期转归的影响
Effects of different anesthesia methods on perioperative immune function and long-term outcome in patients undergoing radical resection of thoracic esophageal carcinoma
  
DOI：10.12089/jca.2019.10.010
中文关键词: 硬膜外阻滞  胸椎旁神经阻滞  食管癌  细胞免疫  远期转归
英文关键词: Epidural block  Thoracic paravertebral nerve block  Esophageal carcinoma  Cellular immunity  Long-term outcome
基金项目:河南省科技攻关计划(162102410042)
作者单位E-mail
阮孝国 450003,河南省人民医院,郑州大学人民医院麻醉科  
丛旭晖 450003,河南省人民医院,郑州大学人民医院麻醉科  
张伟 450003,河南省人民医院,郑州大学人民医院麻醉科  
孙铭阳 450003,河南省人民医院,郑州大学人民医院麻醉科  
张丽媛 450003,河南省人民医院,郑州大学人民医院麻醉科  
张加强 450003,河南省人民医院,郑州大学人民医院麻醉科 hnmzxh@163.com 
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中文摘要:
      
目的 探讨单纯静脉全麻、胸椎旁神经阻滞联合静脉全麻和硬膜外阻滞联合静脉全麻对开胸食管癌切除术患者免疫功能和远期转归的影响。
方法 选择左开胸食管癌切除术患者120例,男74例,女46例,年龄40～75岁,BMI 20～25 kg／m2,ASA Ⅰ或Ⅱ级,采用随机数字表法随机分为三组:单纯静脉麻醉组 (G组)、硬膜外阻滞联合静脉麻醉组(EG组) 和胸椎旁神经阻滞联合静脉麻醉组(PG组),每组40例。EG组于T6-7间隙行硬膜外穿刺并置管,注入0.5％罗哌卡因15 ml,每50分钟注射0.5％罗哌卡因5 ml。PG组于麻醉诱导前行超声引导下术侧胸椎旁神经阻滞,于T4和T7两点各注入0.5％罗哌卡因15 ml。三组均常规行全麻静脉诱导及维持,术后采用PCIA。记录术中麻醉药物、血管活性药物用量。于麻醉诱导前、术毕、术后24、48 h收集中心静脉血液10 ml,采用流式细胞仪测量T淋巴细胞亚群CD3+、CD4+和CD8+浓度。随访患者术后治疗及复发情况,记录生存率和术后复发率。
结果 与G组比较,术毕时PG组、EG组瑞芬太尼用量、血管活性药物使用率明显降低(P＜0.05),术后24 h时EG组和PG组CD3+、CD4+细胞水平明显升高(P＜0.05)。PG组生存率明显高于EG组、G组(P＜0.05)。
结论 相较于单纯静脉全麻及硬膜外阻滞联合静脉全麻,胸椎旁神经阻滞联合静脉全麻可维持食管癌根治术患者术中血流动力学稳定,并改善术后细胞免疫功能及远期转归。
英文摘要:
      
Ojective To investigate the effects of intravenous anesthesia, thoracic paravertebralnerve block combined with intravenous anesthesia and epidural block combined with general anesthesia on immune function and long-term outcome in patients undergoing thoracotomy for esophageal cancer.
Methods One hundred and twenty patients with left thoracotomy for esophageal carcinoma, 74 males and 46 females, aged 40-75 years, with a BMI 20-25 kg／m2, falling into ASA physical status Ⅰ or Ⅱ, were selected and randomly divided into three groups: intravenous anesthesia group (group G), epidural block combined with intravenous anesthesia group (group EG)and thoracic paravertebral nerve block combined intravenous anesthesia group (group PG), 40 cases in each group. Patients in group EG underwent epidural puncture and catheterization between 6th and 7th thoracic vertebra, 15 ml 0.5％ ropivacaine was injected into the space, and the additional 5 ml 0.5％ ropivacaine was added to the catheter every 50 min. In group PG, thoracic paravertebral nerve block was guided by ultrasound before anesthesia induction, 0.5％ ropivacaine 15 ml was injected into thoracic paravertebral space 4 and 7, respectively. All patients in the three groups were induced and maintained by intravenous anesthesia, and patient-controlled intravenous analgesia (PCIA) was given after operation. Dosage of intraoperative anesthetics and vasoactive drugs were recorded. Before anesthesia induction, at the end of operation, 24 and 48 h after operation, 10 ml of central venous blood was collected. The ratio of T cell subsets (CD3+, CD4+, CD8+) was measured by flow cytometry. The patients were followed up for postoperative treatment and recurrence, and the survival rate and recurrence rate were recorded.
Results The level of CD3+and CD4+cells in group EG and group PG were significantly increased at 24 h after operation compared with group C(P ＜ 0.05). At the end of operation, the dosage of remifentanil and the usage of vasoactive drugs in group PG and group EG were significantly decreased compared with group C(P ＜ 0.05). Compared with group EG and group G, the survival rate was significantly improved, and the difference in survival was statistically significant in group PG (P ＜ 0.05).
Conclusion Compared with intravenous general anesthesia and epidural block combined with general anesthesia, thoracic paravertebral nerve block combined with general anesthesia can maintain hemodynamic stability and improve cellular immune function and long-term prognosis in patients undergoing radical resection of esophageal cancer.
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