最近的研究显示，胸段硬膜外阻滞（TEB）可以抑制恶性胸膜间皮瘤（MPM）行胸膜剥离术/去膜术（P/D）后的重大并发症发生，并伴有全身麻醉。为了研究其相关机制，本研究评估了急性炎症状态和围手术期术中痛觉的影响。我们通过一项单中心观察性研究，招募了连续的成年 P/D 手术患者，时间从 2019 年 3 月到 2022 年 4 月。围手术期急性炎症状态通过术前和术后第 1 天的白细胞计数和 C-反应蛋白（CRP）浓度来评估。手术过程中的痛觉水平通过痛觉反应指数（NR）的平均值来评估。进行多变量 logistic 回归分析以确定围手术期变量与重大并发症之间的关联。术后主要并发症定义为 Clavien-Dindo 分级≥III。我们共进行了 97 名患者的研究。经过 logistic 回归分析发现，无 TEB 的全身麻醉是主要并发症的唯一危险因素，因此将患者分为两组：接受 TEB 的全身麻醉组和未接受 TEB 的全身麻醉组。接受 TEB 手术的患者中，主要并发症发生率显著低于未接受 TEB 的患者（33.3％，n=33 对比 64.1％，n=64，P<0.01）。尽管两组间 CRP 水平无显著差异，然而 TEB 手术组的淋巴细胞与单核细胞比值（LMR）在术后第1天显著高于未接受 TEB 的患者（P=0.04）。与未接受 TEB 的患者相比，TEB 手术组的平均 NR 显著更低（P=0.02）。手术过程中较低的平均 NR 和术后第1天较高的 LMR 可能与 TEB 在全身麻醉下进行 P/D 术后抑制重大并发症有关。因 TEB 而导致围手术期急性炎症反应减少，可能有助于抑制 P/D 术后重大并发症。 版权所有©2023 作者。由 Wolters Kluwer Health, Inc. 发布。

A recent study showed that thoracic epidural block (TEB) suppressed the occurrence of major complications after pleurectomy/decortication (P/D) for malignant pleural mesothelioma (MPM) under general anesthesia. To investigate the mechanisms underlying the correlation, both acute inflammatory status and intraoperative nociception were evaluated in the present study. In a single-institutional observational study, consecutive adult patients undergoing P/D were enrolled from March 2019 to April 2022. Perioperative acute inflammatory status was evaluated using differential White blood cell (WBC) counts and serum concentration of C-reactive protein (CRP) both before and after the surgery on postoperative day (POD) 1. The averaged value of nociceptive response index during surgery (mean NR) was obtained to evaluate the level of intraoperative nociception. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications Postoperative major postoperative complication was defined as Clavien-Dindo grades ≥ III. We conducted this study with 97 patients. After logistic regression analysis showed that general anesthesia without TEB was a sole risk factor for major complications, patients were divided into 2 groups: general anesthesia with and without TEB. The incidence of major complications was significantly lower in patients with TEB (33.3%, n = 33) than in those without TEB (64.1%, n = 64, P < .01). Although there was no significant difference in the CRP level between 2 groups, the lymphocyte-to-monocyte ratio (LMR) on POD 1 in patients with TEB was significantly higher than that in patients without TEB (P = .04). The mean NR was significantly lower in patients with TEB than that in those without TEB (P = .02). Both lower mean NR during surgery and higher LMR on POD 1 are likely associated the suppression of major complications due to TEB after P/D under general anesthesia. Decreases in the postoperative acute inflammatory response, caused by the reduction of intraoperative nociception due to TEB, may help suppress major complications after P/D.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.