腹横肌和腰方肌阻滞镇痛用于HIV感染孕产妇剖宫产术后的镇痛效果及对细胞免疫的影响

Effect of ultrasound-guided anesthesia with different block anesthesia on postpartum analgesia and cellular immunity for HIV-infected pregnant women after cesarean section

摘要:

目的： 比较超声引导下腹横肌平面阻滞（transversus abdominis plane block，TAPＢ）镇痛和腰方肌阻滞（quadratus lumborum block，QLB）镇痛用于HIV感染孕产妇剖宫产术后镇痛效果及对细胞免疫的影响。方法： 选择在重庆市公共卫生医疗救治中心接受剖宫产手术的HIV感染孕产妇60例，年龄22~32岁，体质指数（body mass index，BMI）18~25 kg/m²，ASAⅡ级。随机分为TAPB组和QLB组，每组30例。2组均采用腰-硬联合麻醉，术后行静脉自控镇痛（patient controlled intravenous analgesia，PCIA），QLB组术毕行超声引导下腰方肌阻滞，TAPB组行超声引导下腹横肌阻滞。记录术后4、8、12、24、36 h的静态VAS疼痛评分；术前1 d、术后1、2、3 d取外周血，检测白细胞介素（interleukin，IL）-2、IL-13、γ干扰素（interferon-γ，IFN-γ）浓度和CD3⁺、CD4⁺、CD8⁺含量及CD4⁺/CD8⁺；记录镇痛泵首次按压时间、术后补救性镇痛例数、一次穿刺成功率及不良麻醉反应。结果： 与TAPB组术后4、8、12、24、36 h比较，QLB组各时间点静态VAS疼痛评分均明显降低（P<0.05）。与TAPB组术后1、2、3 d比较，QLB组各时间点IL-2、IL-13、IFN-γ浓度和CD4⁺含量以及CD4⁺/CD8⁺均明显升高（P<0.05）。QLB组镇痛泵首次按压时间明显晚于TAPB组，补救性镇痛率明显低于TAPB组（P<0.05）。结论： HIV感染孕产妇剖宫产术后实施经腰方肌阻滞镇痛效果确切，能够减轻对细胞免疫的影响。

Abstract:

Objective: To study the analgesic effect of transversus abdominis plane block（TAPB） and quadratus lumborum block（QLB） on postpartum caesarean section of human immunodeficiency virus（HIV）-infected pregnant women and its influence on cellular immunity. Methods: Sixty HIV-infected pregnant women who underwent cesarean section in Chongqing Public Health Medical Center，aged 22-32，body mass index（BMI） 18-25 kg/m²，ASA Ⅱ. They were randomly divided into TAPB group and QLB group，with 30 cases in each group. Both groups were treated with combined spinal-epidural anesthesia，and underwent patient controlled intravenous analgesia（PCIA） after operation. The QLB group underwent ultrasound-guided bilateral QLB，and ultrasound-guided TAPB was conducted in TAPB group. The scores of resting VAS were recorded at 4 h，8 h，12 h，24 h，36 h after operation. The levels of interleukin（IL）-2，IL-13，interferon-γ（IFN-γ），CD3⁺，CD4⁺，CD8⁺ and CD4⁺/ CD8⁺ in peripheral blood were observed by 1 day before the operation and 1 day，2 days and 3 days after the operation. And the first compression time of the analgesic pump，the number of postoperative salvage analgesia cases，the success rate of one puncture and adverse anesthesia reactions. Results: Compared with the TAPB group at 4 h，8 h，12 h，24 h，and 36 h after surgery，the static VAS pain scores in the QLB group were significantly lower at each time point（P<0.05）. Compared with the TAPB group 1 day，2 days and 3 days after the operation，the IL-2，IL-13，IFN-γ concentration，CD4⁺ and CD4⁺/CD8⁺ in the QLB group were significantly increased at each time point（P<0.05）. The first compression time of the analgesic pump in the QLB group was significantly later than that in the TAPB group（P<0.05），and the rate of remedial analgesia was significantly lower than that in the TAPB group（P<0.05）. Conclusion: Post-operative cesarean section for HIV-infected pregnant women has better analgesia effect with QLB and can reduce the impact on the cellular immunity.