0.5%罗脈卡因星状神经节阻滞对腹部手术后应激反应、免疫和胃肠功能的影响

【目的】探讨0.5%罗哌卡因星状神经节阻滞(SGB)对腹部手术后应激反应、免疫功能和胃肠功能的影响。【方法】在本院接受腹部手术的患者80例,随机分为两组,每组40例。观察组在麻醉诱导前采用0.5%罗哌卡因SGB,对照组注入等量生理盐水。比较两组SGB前5 min、SGB后2 h、4 h、24 h的肿瘤坏死因子-α(TN F-α)、白细胞介素-6(IL-6)、皮质醇(Cor)水平;比较两组术前、术后1 d、3 d的CD3、CD4、CD8、CD4/CD8水平;比较两组术后情况。【结果】①与SGB前5 min比较,观察组SGB后2 h、4 h、24 h的TNF-α、IL-6水平均明显升高,呈现先增高后降低的趋势,且均高于对照组(P<0.05)。与SGB前5 min比较,观察组SGB后2 h、4 h、24 h的Cor水平均逐渐降低,且均低于对照组(P<0.05)。②术后两组CD3、CD4和CD4/CD8均呈现先降低后升高的趋势,CD8均呈现先升高后降低的趋势;观察组术后1 d、3 d的CD3、CD4和CD4/CD8均明显高于对照组,CD8均明显低于对照组(P<0.05)。③观察组肠鸣音恢复时间、肛门排气时间、腹胀发生率均明显低于对照组(P<0.05)。【结论】0.5%罗哌卡因SGB可减轻患者腹部手术后应激反应及免疫功能,有效促进胃肠功能恢复。

Effects of 0.5% Ropivacaine Stellate Ganglion Block on Stress Response,Immune Function and Gastrointestinal Function after Abdominal Operation

【Objective】To investigate the effects of 0.5%ropivacaine stellate ganglion block(SGB)on stress response,immune function and gastrointestinal function after abdominal operation.【Methods】A total of 80 patients who underwent abdominal surgery in our hospital were randomly divided into two groups,with 40 cases in each group.Patients in the observation group received 0.5% ropivacaine SGB before induction of anesthesia,while patients in the control group received the same amount of normal saline.The levels of TNF-α,IL-6 and Cor(cortisol)were compared between the two groups at 5 min before SGB and at 2 h,4 h and 24 h after SGB.The levels of CD3,CD4,CD8 and CD4/CD8 were compared at 1 day before surgery and 3 days after operation.The recovery time of postoperative bowel sounds,anal exhaust time and bloating occurred in the groups were recorded.【Results】(1)Compared to 5 min before SGB,the levels of TNF-α and IL-6 in the observation group increased significantly at 2h,4h and 24h after SGB,which showed a trend of increasing first and then decreasing.Meanwhile levels of TNF-α and IL-6 in the observation group were higher than those in the control group(P<0.05).The levels of Cor at 2 h,4 h,and 24 h after SGB in the observation group decreased gradually if compared to 5 min before SGB.The levels of Cor in the observation group were lower than those in the control group(P<0.05).(2)The levels of CD3,CD4 and CD4/CD8 in the two groups decreased first and then increased,while CD8 increased first and then decreased.CD3,CD4 and CD4/CD8 in the observation group at 1 and 3 days after operation were significantly higher than those in the control group,while CD8 in the observation group was significantly lower than that in the control group(P<0.05).(3)The recovery time of bowel sounds,anal exhaust time and incidence of abdominal distension in the observation group were significantly lower than those in the control group(P<0.05).【Conclusion】0.5% ropivacaine SGB can reduce the stress response and immune function of patients after abdominal surgery,and effectively promote the recovery of gastrointestinal function.