1％利多卡因星状神经节阻滞对择期腹腔镜胆囊切除术患者循环功能及免疫功能的影响

摘要

Objective To investigate the effect of stellate ganglion block(SGB) with 1％ lidocaine before anesthesia induction on circulatory function and immune function in patients undergoing elective laparoscopic cholecystectomy(LC).Methods Sixty patients undergoing elective LC from March to December 2016 in the First Hospital Affiliated of Hebei North University were randomly divided into observation group and control group,with 30 cases in each group.The control group was injected 10 ml 0.9％ sodium chloride while the observation group was injected 10 ml 1％ lidocaine at the root of right C6 transverse process under the guidance of ultrasound 30 min before anesthesia induction.Circulatory function indexes were monitored before SGB(T0),during tracheal intubation (T1),5 min after pneumoperitoneum(T2),at the end of pneumoperitoneum (T3),5 min after extubation (T4),6 h after operation(T5) and 8 h after operation(T6).Immune function indexes were tested at T0,T5,the 1st day after operation(T7) and the 3rd day after operation(T8).Visual Analogue Scale for pain was assessed at different time points after operation.Results Heart rate and mean arterial pressure at T2-T5 and end-tidal carbon dioxide partial pressure at T2 and T3 in the observation group were significantly lower than those in the control group (all P ＜ 0.05).CD3+,CD4+ and CD4+/CD8+ in the observation group at T5 were significantly higher than those in the control group[(60 ±7)％ vs (56 ±7)％,(37 ±5)％ vs (35 ±4)％,(1.85 ±0.40) vs (1.63 ±0.35)];CD4+ and CD4+/CD8+ at T7 in the observation group were significantly higher than those in the control group [(39 ± 4)％ vs (36 ± 5) ％,(1.78 ± 0.29) vs (1.53 ± 0.20)] (all P ＜ 0.05).VAS scores at T5 and T7 in the observation group were significantly lower than those in the control group[(2.6 ±0.6) vs (3.0 ±0.6),(1.8 ±0.6) vs (2.4 ±0.4)](t =2.582,4.557,both P ＜ 0.05).Conclusion SGB with 1％ lidocaine shows a good postoperative analgesia effect on patients undergoing LC and little effect on the circulatory function and immune system.%目的 探讨麻醉诱导前应用1％利多卡因星状神经节阻滞对择期腹腔镜胆囊切除术(LC)患者循环功能指标及免疫功能指标水平的影响.方法 选择河北北方学院附属第一医院2016年3-12月择期行LC的患者60例,应用随机数字表法分为观察组和对照组,各30例,对照组患者麻醉诱导前30 min在超声引导下于右侧C6横突根部注射0.9％氯化钠注射液10 ml,观察组注射1％利多卡因10 ml;比较2组患者星状神经节阻滞前(T0)、气管插管即刻(T1)、气腹建立后5 min(T2)、气腹结束(T3)、拔管后5 min(T4)、术后6 h(T5)、术后8 h(T6)循环功能指标水平,T0、T5、术后第1天(T7)、术后第3天(T8)免疫功能指标水平,以及术后各时点疼痛视觉模拟量表评分.结果 与对照组同时点比较,观察组T2～T5时点心率、平均动脉压以及T2、T3时点潮气末二氧化碳分压均降低,差异均有统计学意义(均P＜0.05).与对照组同时点比较,观察组T5时点CD3+、CD4+、CD4+/CD8+比值[(60±7)％比(56±7)％,(37±5)％比(35±4)％,(1.85±0.40)比(1.63±0.35)]以及T7时点CD4+、CD4+/CD8+比值[(39±4)％比(36±5)％,(1.78±0.29)比(1.53±0.20)]均升高,差异均有统计学意义(均P＜0.05).观察组术后T5、T7时点疼痛视觉模拟量表评分均明显低于对照组[(2.6±0.6)分比(3.0±0.6)分,(1.8±0.6)分比(2.4±0.4)分],差异均有统计学意义(t=2.582、4.557,均P＜0.05).结论 1％利多卡因星状神经节阻滞麻醉对LC患者循环功能及免疫系统的影响小,术后镇痛良好.