3型腰方肌阻滞对腹腔镜根治性胃癌切除术术后细胞介导免疫及镇痛的疗效：一项前瞻性随机对照试验
Efficacy of quadratus lumborum block type 3 on postoperative cell-mediated immunity and analgesia for laparoscopic radical gastrectomy: a prospective randomized controlled trial.
作者信息
Wang Fuchun, Xie Tian, Guo Yan, Bai Chen, Xu Mingcan, Wang Xiaoyu, Feng Chang
机构信息
Department of General Surgery, The Second People's Hospital of Caoxian, Shandong, China.
Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, China.
出版信息
Surg Endosc. 2025 May;39(5):3317-3327. doi: 10.1007/s00464-025-11727-z. Epub 2025 Apr 15.
PURPOSE
Various methods have been formulated to reduce pain and relieve immunosuppression in order to improve prognosis. The current study aimed to evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) on the postoperative analgesia and perioperative cell-mediated immunity in patients underwent laparoscopic radical gastrectomy.
PATIENTS AND METHODS
A total of 54 patients scheduled for laparoscopic radical gastrectomy were randomly evenly assigned into both groups. The participants in Group Q received US-guided QLB 3 bilaterally with ropivacaine (0.25%, 30 mL on each side) before surgery along with GA, and those in Group C received GA without any special treatment. Both groups were given patient-controlled intravenous analgesia postoperatively. The primary outcomes were the T-cell subsets and Natural killer (NK) cell level at 30 min before surgery (T0) and at 0, 12, 24, and 48 h postoperatively (T1, T2, T3, and T4) were measured. The secondary outcomes were as fellows: the visual analog scale (VAS) pain score (rest and movement) at T1, T2, T3, and T4. In addition, the opioid consumption, and the incidence of postoperative adverse reactions.
RESULTS
The level of CD3 + , CD4 + T, and natural killer (NK) cells, besides the CD4 + /CD8 + ratio showed less reduction at T1, T2, T3, and T4 in Group Q (P < 0.05). The VAS pain scores (at rest and on movement) were significantly lower in Group Q at T1-T4 (P < 0.05). Opioid consumption and the incidence of adverse reactions were lower in Group Q (P < 0.05).
CONCLUSION
For patients undergoing LRG, the ultrasound-guided QLB 3 could alleviate perioperative cell-mediated immunity suppression, improve postoperative analgesia, decrease opioid consumption, and reduce the incidence of adverse reactions.
CLINICAL TRIAL REGISTRATION NUMBER
The Chinese Clinical Trial Registry (ChiCTR2000034592).
目的
已制定多种方法来减轻疼痛和缓解免疫抑制，以改善预后。本研究旨在评估超声引导下腰方肌阻滞（QLB）对接受腹腔镜根治性胃切除术患者术后镇痛及围手术期细胞介导免疫的影响。
患者与方法
总共54例计划接受腹腔镜根治性胃切除术的患者被随机均匀分为两组。Q组患者在手术前双侧接受超声引导下的QLB 3，使用罗哌卡因（0.25%，每侧30 mL），同时接受全身麻醉（GA），C组患者仅接受GA，无任何特殊处理。两组患者术后均给予患者自控静脉镇痛。主要观察指标为术前30分钟（T0）以及术后0、12、24和48小时（T1、T2、T3和T4）的T细胞亚群和自然杀伤（NK）细胞水平。次要观察指标如下：T1、T2、T3和T4时的视觉模拟评分（VAS）疼痛评分（静息和活动时）。此外，还包括阿片类药物消耗量及术后不良反应发生率。
结果
Q组在T1、T2、T3和T4时，CD3 +、CD4 + T和自然杀伤（NK）细胞水平以及CD4 + /CD8 + 比值的降低幅度较小（P < 0.05）。Q组在T1 - T4时的VAS疼痛评分（静息和活动时）显著更低（P < 0.05）。Q组的阿片类药物消耗量和不良反应发生率更低（P < 0.05）。
结论
对于接受腹腔镜根治性胃切除术的患者，超声引导下的QLB 3可减轻围手术期细胞介导的免疫抑制，改善术后镇痛，减少阿片类药物消耗量，并降低不良反应发生率。
临床试验注册号
中国临床试验注册中心（ChiCTR2000034592）
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