Relationship between anesthesia factor and postoperative cellular immune function in patients undergoing radical resection for esophageal cancer: value of thoracic paravertebral block combined with general anesthesia
10.3760/cma.j.issn.0254-1416.2017.06.001
- VernacularTitle:麻醉因素与开胸食管癌根治术患者术后细胞免疫功能的关系:胸椎旁神经阻滞联合全身麻醉的价值
- Author:
Hongfang GENG
;
Xuhui CONG
;
Wei ZHANG
;
Liyuan ZHANG
;
Jiaqiang ZHANG
- Keywords:
Nerve block;
Anesthesia,general;
Immunity,cellular;
Esophageal neoplasms
- From:
Chinese Journal of Anesthesiology
2017;37(6):641-644
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the optimized efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia via the research on the postoperative cellular immune function in the patients undergoing radical resection for esophageal cancer.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 45-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical resection for esophageal cancer,were divided into 2 groups (n =20 each) using a random number table:general anesthesia group (G group) and TPVB combined with general anesthesia group (TPVB+G group).In group TPVB+G,TPVB was performed at T4 and T6 on the operated side under ultrasound guidance with 0.5％ ropivacaine 15 ml before anesthesia induction.Anesthesia induction was started after the level of block was confirmed.Anesthesia was maintained with propofol given by target-controlled infusion at the target plasma concentration of 1-4 μg/ml,and bispectral index value was maintained at 40-50.Patient-controlled intravenous analgesia was performed after operation,and visual analog scale score was maintained ≤ 3.Before anesthesia induction,at the end of operation and at 24 and 48 h after operation,blood samples were collected from the central vein for determination of the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ and CD4+/CD8+ ratio.Ricker Sedation-Agitation Scale scores were recorded at 10 min,20 min,30 min and 1 h after extubation and 6,24 and 48 h after operation.The consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia,the number of unsuccessfully delivered doses and the total number of attempts were also recorded.Results Compared with group G,Ricker Sedation-Agitation Scale scores were significantly decreased at 10 min after extubation,the consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia and the number of unsuccessfully delivered doses were decreased,and the postoperative CD4+ level and CD4 +/CD8 + ratio were increased in group TPVB+G (P＜0.05).Conclusion TPVB combined with general anesthesia can improve the postoperative cellular immune function and is an optimal anesthesia regimen in the patients undergoing radical resection for esophageal cancer.
