| Objective To investigate the impact of ultrasound-guided serratus anterior plane block（SAPB）combined with general anesthesia on immune function in patients undergoing thoracoscopic resection of pulmonary nodules during the period of perioperative.Methods Eighty patients,aged from 30～70 years old and American Society of Anesthesiologists physical status fromⅡtoⅢ,with body mass index of 18～30 kg/m2,were scheduled for elective thoracoscopic resection of pulmonary nodules.They were randomly divided into two groups（n=40）,anterior serratus block group（group S）and routine contral group（group C）.SAPB was injected with 0.375%ropivacaine 20ml under ultrasound-guided before general anesthesia in group S and routine general anesthesia was undertaken in group C.MAP and HR were recorded before anesthesia（T0）,at the point of skin incision（T1）,at the end of operation（T2）,after extubation of double lumen tube in 5 min（T3）,24 h after operation（T4）and 48 h after operation（T5）.The total intravenous consumption of propofol and remifentanil,the duration of the recovery spontaneous breathing（from withdrawal medication to recovery of spontanious breathing）,the duration of recovery（withdrawal medicaiton to open eyes）,the duration of extubation（withdrawl medication to extubation of double lumen tube）,the RASS score at T3 point,the VAS score of rest and during movement at T3,T4 and T5point were recorded.The consumption of rescue analgesic,the incidence of nausea,vomiting and pruritus in 48 h after operation were recorded.The results of arterial blood gas at T0,T3 and T4 point were recorded.The stay and expense of postoperative hospitalization,the length of ICU stay,the time of exhaust and drainge tube retention were recorded.Venous blood samples were taken to measure the plasma concentration of IFN-γand IL-4 to represent the level of helper T lymphocyte 1（Th1）and helper T lymphocyte2（Th2）at T0 and T4 point.Results1 Comparison of the total consumption of propofol and remifentanil in two groups:The total consumption of remifentanil in S group was significantly less than group C（P<0.05）,and no difference in the total consumption of propofol in two groups（P>0.05）.2 Comparison of duration of the recovery spontaneous breathing,the duration of recovery,the duration of extubation:The duration of the recovery spontaneous breathing,recovery and extubation in group S were significantly less than group C（P<0.05）.3 Comparison of RASS score and VAS score after extubation in two groups:Compared with group C,RASS score was lower in group S at T3point（P<0.05）,VAS score at rest and during movement in group S were lower significantly at T3 to T5 point（P<0.01）.4 Comparison of hemodynamic indexs in two groups:No difference was found at T0 point in both groups（P>0.05）;Compared with group C,the MAP and HR were lower significantly at T2 to T5 point in group S（P<0.05）.5 Comparison of consumption of rescue analgesic in 48h and related indexes of postoperative rehabilitation after operation in two groups:The total consumption of rescue analgesics in 48 h were lower significantly in group S（P<0.001）;Compared with group C,the incidence of nausea,vomiting and pruritus in 48 h after operation were lower in group S（P<0.05）;Compared with group C,the length of ICU stay was shorter in group S（P<0.01）;Compared with group C,the time of exhaust and drainge tube retention were shorter in group S（P<0.001）;Compared with group C,the stay of postoperative hospitalization was less in group S（P<0.01）.6 Comparison the plasma concentration of IFN-γ/IL-4 at T0 and T4point in two groups:Compared with group C,the concentration of IFN-γ/IL-4 was significantly lower in group S at T4 point（P<0.05）.Conclusion Ultrasound-guided anterior serratus muscle block before operation could not only ameliorate the immune sureillance of patients undergoing video-assisted thoracoscopic surgery,but also reduce the consumption of analgesics used during operation,and facilitate the recovery of postoperative patients. |
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