超声引导下竖脊肌平面阻滞对乳腺癌根治术患者免疫功能及术后恢复的影响
Effects of ultrasound-guided erector spinae plane block on the immune function and postoperative recovery of patients undergoing radical mastectomy.
作者信息
Hu Yunxia, Li Meiting, Li Jiacen, Lyu Qiang, Jiang Rong, Du Yu
机构信息
Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
出版信息
Gland Surg. 2021 Oct;10(10):2901-2909. doi: 10.21037/gs-21-603.
BACKGROUND
To explore the effects of ultrasound-guided erector spinae plane (ESP) block on the immune function and postoperative recovery of patients undergoing radical mastectomy.
METHODS
One hundred and four patients with breast cancer were randomly divided into the observation group and control group, with 52 cases in each group. The control group underwent induction of routine general anesthesia and thoracic paravertebral block, while the observation group underwent ultrasound-guided ESP block combined with general anesthesia. The recovery of autonomous respiration, eye opening, extubation time, postoperative eating, first anal exhaust, leaving bed and hospitalization time in both groups were statistically analyzed after surgery. The immune function indexes [CD4+, CD8+, interferon-γ (IFN-γ)] and the expression levels of serum neuropeptide Y (NPY), prostaglandin E2 (PGE2) and serotonin (5-HT) were compared between the two groups at 24 and 48 h before and after surgery. The visual analog scale (VAS) scores at rest and during exercise were recorded at 6, 12, 24, and 48 h after surgery.
RESULTS
There was no significant difference in the recovery of autonomous respiration, eye opening, and extubation time between the two groups (P>0.05). However, postoperative eating, first anal exhaust, leaving bed, and hospitalization time in the observation group were shorter than those in the control group (P<0.05). At 24 and 48 h after surgery, compared with the control group, CD4+ and IFN-γ levels were increased significantly (P<0.05), CD8+ and levels of serum NPY, PGE2, 5-HT and the incidence of postoperative complications was decreased significantly in the observation group (P<0.05). VAS scores at rest and during exercise in the observation group were lower than those in the control group (P<0.05). At 5 and 10 min after intubation, the observation group had higher epinephrine (E) level and lower serum cortisol (Cor) level than the control group (P<0.05).
CONCLUSIONS
The analgesic effect of ultrasound-guided ESP block is significant after radical mastectomy. There are few adverse reactions and few effects on immune function, and it can promote the postoperative recovery of patients.
背景
探讨超声引导下竖脊肌平面（ESP）阻滞对乳腺癌根治术患者免疫功能及术后恢复的影响。
方法
将104例乳腺癌患者随机分为观察组和对照组，每组52例。对照组采用常规全身麻醉诱导联合胸椎旁阻滞，观察组采用超声引导下ESP阻滞联合全身麻醉。术后对两组患者自主呼吸恢复、睁眼、拔管时间、术后进食、首次肛门排气、下床及住院时间进行统计学分析。比较两组患者手术前后24 h和48 h的免疫功能指标[CD4 +、CD8 +、干扰素-γ（IFN-γ）]以及血清神经肽Y（NPY）、前列腺素E2（PGE2）和5-羟色胺（5-HT）的表达水平。记录术后6、12、24和48 h静息及运动时的视觉模拟评分（VAS）。
结果
两组患者自主呼吸恢复、睁眼及拔管时间比较，差异无统计学意义（P>0.05）。然而，观察组术后进食、首次肛门排气、下床及住院时间均短于对照组（P<0.05）。术后24 h和48 h，与对照组比较，观察组CD4 +和IFN-γ水平显著升高（P<0.05），CD8 +以及血清NPY、PGE2、5-HT水平和术后并发症发生率显著降低（P<0.05）。观察组静息及运动时VAS评分低于对照组（P<0.05）。插管后5 min和10 min，观察组肾上腺素（E）水平高于对照组，血清皮质醇（Cor）水平低于对照组（P<0.05）。
结论
超声引导下ESP阻滞用于乳腺癌根治术后镇痛效果显著，不良反应少，对免疫功能影响小，可促进患者术后恢复。
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