胸腔镜下肺叶切除术患者围术期多模式镇痛效果及其对免疫功能的影响

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Abstract Objective To investigate the effects of multimodal analgesia on perioperative analgesia and immune function in patients undergoing thoracoscopic lobectomy. Methods Ninety patients with lung resection under thoracoscope (51 males, 39 females, and aged 18 to 65) were randomly and evenly divided into three groups:the control group in which patient-controlled intravenous analgesia(PCIA)was adopted, Preemptive analgesia group that received flurbiprofen axetil +PCIA, and the multimodal analgesia group where flurbiprofen axetil+thoracic paravertebral nerve block (TPVB)+ PCIA was used. The usage of intraoperative propofol, remifentanil dosage and additional dosage of sufentanil were recorded. The VAS scores at postoperative 6, 24, 48 h and the number of times the analgesia pump was pressed within 48 h were calculated. Venous blood samples were collected before anesthesia (T₀), at the end of the surgery(T₁), and on the morning of one day(T₂) and three days (T₃) after operation. The levels of T lymphocyte subsets(CD3⁺ , CD4⁺ and CD8⁺ ) and NK cells were measured by flow cytometry, and the ratio of CD4⁺/CD8⁺ was calculated.Results Compared with control group, the dosage of remifentanil and sufentanil supplementation in preemptive analgesia group and multimodal analgesia group were significantly decreased (P<0.05); In preemptive analgesia group,the VAS score at 6 h after surgery was significantly decreased (P<0.05), the percentage of NK cells at T₁ and the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ were significantly increased (P<0.05); In multimodal analgesia group, the VAS scores at 6 h and 24 h after surgery were significantly decreased (P<0.05), the analgesia pump was pressed less frequently(P<0.05), the percentage of NK cells and the levels of CD3⁺, CD4⁺,CD4⁺/CD8⁺ at T₁ and T₂, and the levels of CD3⁺ and CD4⁺ at T₃ were increased(P<0.05), and the incidence of postoperative nausea and vomiting group was lower (P<0.05).Conclusions For thoracoscopic lobectomy, multimodal analgesia can enhance postoperative analgesia, reduce perioperative opioid dosage, alleviate immunosuppression, and increase no incidence of postoperative nausea and vomiting. Besides, flurbiprofen ester combined with paravertebral nerve block had can contribute more to perioperative analgesia and immune function.

Key words： multimodal analgesia paravertebral nerve block preemptive analgesia lung cancer immune function

Received: 01 February 2021

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	WU Shufang
	ZHANG Meifeng
	NING Xinyu

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WU Shufang,ZHANG Meifeng,NING Xinyu. Effects of multimodal analgesia on perioperative analgesia and immune function in patients undergoing thoracoscopic lobectomy[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(6): 468-471.

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http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2021/V32/I6/468

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