超声引导下胸椎旁阻滞与前锯肌平面阻滞在乳腺癌根治术患者术后镇痛的对比研究  

Comparison postoperative analgesic efficacy of ultrasound⁃guided thoracic paravertebral block versus serratus plane block for modified radical mastectomy

作　　者：庄凌云 齐敦益[2] 徐达 陆瑞斌[3] 陆志强 ZHUANG Lingyun;QI Dunyi;XU Da;LU Ruibin;LU Zhiqiang(Xuzhou Medical University,Xuzhou 221000,China;不详)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]徐州医科大学附属医院麻醉科,江苏徐州221000 [3]常州市中医医院麻醉科,江苏常州213000 [4]南京医科大学第二附属医院麻醉科,南京210000

出　　处：《实用医学杂志》2020年第12期1659-1664,共6页The Journal of Practical Medicine

基　　金：南京医科大学科技发展基金⁃面上项目(编号:2017NJMU030)。

摘　　要：目的比较超声引导下胸椎旁阻滞(Thoracic paravertebral block,TPVB)和前锯肌阻滞(serratus plane block,SPB)在乳腺癌改良根治术患者的术后镇痛效果.方法2017年2月-2018年11月从我院选择单侧乳腺癌根治术患者89例,随机分为3组,TPVB组:静脉自控镇痛(PCIA)复合单次胸椎旁阻滞组(n=29)、SPB组:静脉自控镇痛复合单次前锯肌阻滞组(n=30)、对照组:静脉自控镇痛组(n=30).麻醉诱导前行超声引导下术侧TPVB和SPB,两组均注射0.5%罗哌卡因25 mL,对照组患者行全凭静脉麻醉.术后3组均予枸橼酸芬太尼PCIA.于术后2、4、6、24、48、72 h行视觉模拟疼痛评分(Visual Analogue Scale,VAS),并记录术后24、48、72h内芬太尼用量,检测并记录3组白细胞介素6(IL-6)分别在术前(T0)、术后1 h(T1)、术后4 h(T2)、术后24 h(T3)的值.记录3组术后恶心、呕吐等不良反应发生情况和神经阻滞相关并发症.比较术后3组患者的芬太尼消耗量和VAS评分,比较3组的有效镇痛时间,比较3组术后恶心、呕吐等不良反应的发生率.结果术后TPVB组的镇痛时间长于SPB组(P<0.05).术后3组的芬太尼消耗量均随时间而增加,TPVB组0.05),术后3组的IL-6水平均随时间先升高后降低,TPVB组0.05).呕吐:PVB组和对照组,SPB组和对照组的组间差异具有统计学意义(P<0.05);TPVB组和SPB组差异无统计学意义(P>0.05).结论超声引导下TPVB与SPB都能减少乳腺癌改良根治术患者术后疼痛,都能减少炎症因子的释放.但TPVB的炎症因子释放更少,有效镇痛时间更长,芬太尼的消耗量更少,患者的VAS评分更低,镇痛效果更佳,TPVB组和SPB组与对照组相比不良反应发生率都较少.Objective To compare the postoperative analgesic effect of ultrasound⁃guided thoracic paravertebral block(TPVB)and anterior serrated muscle block(SPB)in patients with modiffied radical mastectomy.Methods From February 2017 to November 2018,89 patients with unilateral radical mastectomy were selected from our hospital and randomly divided into three groups:(TPVB group)Patient controlled intravenous analgesia(PCIA)combined with single thoracic paraspinal block group(n=29),(SPB group)PCIA combined with single serratus anterior block group(n=30)and(control group)PCIA combined with general anesthesia group(n=30).TPVB and SPB were guided by ultrasound before anesthesia induction on the operative side,both groups were injected with 0.5%ropivacaine 25 mL,while patients in the control group were given total intravenous anesthesia.Three groups received PCIA with fentanyl after surgery.VAS was performed at 2,4,6,24,48 and 72 h after the operation,and fentanyl dosage was recorded at 24,48 and 72 h after the operation.The values of interleukin⁃6(IL⁃6)in the three groups were detected and recorded at preoperative(T0),1 h(T1)after surgery,4 h(T2)after surgery,and 24h(T3)after surgery.Postoperative adverse reactions and complications related to nerve block in three groups were recorded.Fentanyl consumption and VAS in the three groups of patients were compared after surgery,the effective analgesic time in the three groups was compared,blood IL⁃6 levels in the three groups at different time periods were compared,and the incidence of postoperative nausea,vomiting and other adverse reaction in three groups were compared.Results Postoperative analgesia time in TPVB group was longer than that in SPB group(P<0.05).Postoperative fentanyl consumption increased with time in all the three groups,TPVB group<SPB group<control group;There were statistically significant differences between the three groups and at different points of time(P<0.05).VAS of the three groups showed a trend of first increasing and then decreasing with time af

关 键 词：超声引导 胸椎旁阻滞 前锯肌平面阻滞 乳腺癌改良根治术 炎症因子 术后镇痛 

分 类 号：R614.4[医药卫生—麻醉学] R737.9[医药卫生—外科学]