超声引导下胸椎旁神经阻滞复合全身麻醉对乳腺癌患者术后镇痛及免疫细胞功能的影响

目的:探讨超声引导下胸椎旁神经阻滞复合全身麻醉对乳腺癌患者术后镇痛及免疫细胞功能的影响。方法:将78例行乳腺癌根治术的患者随机分成全身麻醉组及复合麻醉组。复合麻醉组患者在麻醉诱导前经超声引导下胸椎旁神经阻滞，麻醉诱导后吸入七氟醚；全身麻醉组患者在麻醉诱导后吸入七氟醚，术后均采用瑞芬太尼静脉自控镇痛(PCIA)。比较两组患者在术后1天、术后2天及术后3天视觉模拟评分(VAS)及两组患者术后镇痛持续时间和24 h内舒芬太尼用量；分别于术前、手术结束时、术后1天及术后3天时采用流式细胞仪分析法测定两组患者T淋巴细胞亚群及NK细胞值。结果:复合麻醉组患者在术后1天及术后2天时VAS评分均低于全身麻醉组(P＜0.01)，两组患者在术后3天时VAS评分无统计学差异(P＞0.05)；复合麻醉组患者镇痛持续时间多于全身麻醉组患者(P＜0.01)；复合麻醉组患者24 h内舒芬太尼用量少于全身麻醉组患者(P＜0.01)；两组患者在手术结束时、术后1天及术后3天时CD3+、CD4+、CD4+/CD8+及NK细胞值均低于术前(P＜0.05)；复合麻醉组患者在手术结束时、术后1天及术后3天时CD3+、CD4+、CD4+/CD8+及NK细胞值均高于全身麻醉组患者(P＜0.05)。结论:乳腺癌根治术麻醉诱导前行超声引导下胸椎旁神经阻滞复合全身麻醉能够提供更加显著的镇痛效果，对T淋巴细胞的抑制更少，同时能够保护NK细胞活性，对患者免疫功能的影响更小。

Effect of ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia on postoperative analgesia and immune cell function in patients with breast cancer

Objective:To explore the effect of ultrasound-guided thoracic paravertebral block combined with general anesthesia on postoperative analgesia and immune cell function in patients with breast cancer.Methods:Seventy-eight patients undergoing radical mastectomy were randomly divided into general anesthesia group and compound anesthesia group.Patients in the compound anesthesia group underwent ultrasound-guided parathoracic nerve block before induction of anesthesia,and inhaled sevoflurane after induction of anesthesia.Patients in the general anesthesia group inhaled sevoflurane after induction of anesthesia,and remifentanil was used for patient-controlled intravenous analgesia (PCIA).The visual analogue scale (VAS) at 1 day,2 days,and 3 days after surgery,the duration of postoperative analgesia and the amount of sufentanil within 24 hours of the two groups of patients were compared.T lymphocyte subsets and NK cell values were measured by flow cytometry at the preoperation,the end of surgery,1 day after surgery and 3 days after surgery.Results:VAS scores of patients in the compound anesthesia group were lower than those in the general anesthesia group at 1 day and 2 days after surgery (P＜0.01),and there was no difference in VAS scores between the two groups at 3 days after surgery (P＞0.05).The analgesia duration of patients in compound anesthesia group was longer than that in general anesthesia group (P＜0.01).The dosage of sufentanil in the compound anesthesia group was less than that in the general anesthesia group at 24 h (P＜0.01).The proportion of CD3+,CD4+,CD4+/CD8+ and NK cells of patients in the two groups at the end of surgery,1 day after surgery and 3 days after surgery were all lower than those the preoperation (P＜0.05).The proportion of CD3+,CD4+,CD4+/CD8+ and NK cells in the compound anesthesia group were higher than those in the general anesthesia group at the end of surgery,1 day after surgery and 3 days after surgery (P＜0.05).Conclusion:The ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia before anesthesia induction of radical mastectomy for breast cancer patients can provide more significant analgesic effect,inhibit T lymphocytes less,protect NK cell activity and have less impact on patients' immune function.