2026 年第 5 期 第 21 卷

瑞芬太尼全身麻醉联合胸椎旁神经阻滞对老年肾癌手术患者镇痛效果和免疫炎症反应的影响

Effects of remifentanil general anesthesia combined with thoracic paravertebral nerve block on analgesic effect and immune-inflammatory response in elderly patients undergoing renal cancer surgery

作者：何金玲张媛云乐天王丽斯

英文作者：He Jinling Zhang Yuan Yun Letian Wang Lisi

单位：内蒙古自治区人民医院麻醉科，呼和浩特010017

英文单位：Department of Anesthesiology Inner Mongolia People′s Hospital Hohhot 010017 China

关键词：肾癌；瑞芬太尼；胸椎旁神经阻滞；镇痛；免疫功能；炎症因子

英文关键词：Renalcancer;Remifentanil;Thoracicparavertebralnerveblock;Analgesia;Immunefunction;Inflammatoryfactors

• 摘要：

• 目的 探讨瑞芬太尼全身麻醉联合胸椎旁神经阻滞对老年肾癌手术患者镇痛效果和免疫炎症反应的影响。方法 选取2024年2月至2025年7月于内蒙古自治区人民医院择期行后腹腔镜肾癌根治术的146例老年肾癌患者作为研究对象，采用随机数字表法将患者分为对照组和观察组，每组73例。对照组采用瑞芬太尼为核心的全身麻醉，观察组采用瑞芬太尼为核心的全身麻醉联合胸椎旁神经阻滞。比较2组患者不同时点镇痛效果、平均动脉压（MAP）、心率、免疫功能指标、自然杀伤细胞、炎症因子水平，比较2组患者不良反应发生情况。结果 2组患者不同状态下的视觉模拟量表（VAS）评分存在组间、时间和交互效应（均P<0.05），且观察组不同状态下的术后12、24、48 h VAS评分均低于对照组（均P＜0.05）。2组患者不同时点的MAP和心率存在组间、时间和交互效应（均P＜0.05），且观察组切皮时的MAP和心率均低于对照组（均P＜0.05）。2组患者不同时点的CD+3、CD+4、CD+8、CD+4/CD+8比值和自然杀伤细胞存在组间和时间效应（均P＜0.05），且观察组术后24 h的CD+3、CD+4、CD+4/CD+8比值和自然杀伤细胞水平均高于对照组，而CD+8水平低于对照组（均P＜0.05）。2组患者不同时点的炎症因子水平存在组间和时间效应（均P＜0.05），且观察组术后24 h的炎症因子水平均低于对照组（均P＜0.05）。观察组和对照组患者不良反应发生率比较差异无统计学意义［6.8%（5/73）比5.5%（4/73）］（χ2<0.001，P=1.000）。结论 瑞芬太尼全身麻醉联合胸椎旁神经阻滞对老年肾癌手术患者的镇痛效果明显，能够有效改善免疫功能，抑制炎症反应，提高老年肾癌患者手术的安全性。

• Objective To investigate the effects of remifentanil general anesthesia combined with thoracic paravertebral nerve block on analgesic effect and immune-inflammatory response in elderly patients undergoing renal cancer surgery. Methods A total of 146 elderly renal cancer patients undergoing elective retroperitoneal laparoscopic radical nephrectomy at Inner Mongolia People′s Hospital from February 2024 to July 2025 were enrolled. They were divided into control group and observation group by random number table method, with 73 cases in each group. The control group received remifentanil-based general anesthesia, and the observation group received remifentanil-based general anesthesia combined with thoracic paravertebral nerve block. The analgesic effect, mean arterial pressure (MAP), heart rate, immune function indexes, natural killer cells and inflammatory factors at different time points, as well as the incidence of adverse reactions were compared between the two groups. Results There were significant inter-group, time and interaction effects in visual analogue scale (VAS) scores at different states between the two groups (all P<0.05), and the VAS scores at 12 h, 24 h and 48 h after operation in the observation group were lower than those in the control group (all P<0.05). There were significant inter-group, time and interaction effects in MAP and heart rate at different time points between the two groups (all P<0.05), and MAP and heart rate at skin incision in the observation group were lower than those in the control group (all P<0.05). There were significant inter-group and time effects in CD+3, CD+4, CD+8, CD+4/CD+8 ratio and natural killer cells at different time points between the two groups (all P<0.05). At 24 h after operation, the levels of CD+3, CD+4, CD+4/CD+8 ratio and natural killer cells in the observation group were higher than those in the control group, while the level of CD+8 was lower (all P<0.05). There were significant inter-group and time effects in inflammatory factors at different time points between the two groups (all P<0.05), and the levels of inflammatory factors at 24 h after operation in the observation group were lower than those in the control group (all P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group ［6.8%(5/73) vs 5.5%(4/73)］(χ2<0.001, P=1.000). ConclusionsRemifentanil general anesthesia combined with thoracic paravertebral nerve block has obvious analgesic effect in elderly patients undergoing renal cancer surgery, which can effectively improve immune function, inhibit inflammatory response and enhance the safety of surgery in elderly renal cancer patients.