超声引导下胸横肌平面-胸神经阻滞和胸椎旁神经阻滞用于乳腺癌改良根治术的效果比较  

Comparison of effect between ultrasound-guided transversus thoracic muscle plane-pectoral nerves block and thoracic paravertebral nerve block in patients underdoing modified radical mastectomy

作　　者：赵赢 费建平[1] 雷月[1] 邵安民[1] ZHAO Ying;FEI Jianping;LEI Yue;SHAO Anmin(Department of Anesthesiology,the Traditional Chinese Medicine Hospital of Kunshan,Jiangsu Kunshan 215300,China)

机构地区：[1]昆山市中医医院麻醉科,江苏昆山215300

出　　处：《现代肿瘤医学》2021年第5期877-882,共6页Journal of Modern Oncology

基　　金：昆山市社会发展科技专项项目(编号:ks18037)。

摘　　要：目的:比较超声引导下胸横肌平面-胸神经阻滞(TTP-PECS)和胸椎旁神经阻滞(TPVB)用于乳腺癌改良根治术的效果。方法:将80例择期行单侧乳腺癌改良根治术的女性患者,ASAⅠ-Ⅱ级,年龄28~74岁,身高151~172 cm,体重47~72 kg,采用随机数字表法分为2组(n=40):TTP-PECS组(TP组)和TPVB组(T组)。TP组行超声引导下患侧TTP-PECS,T组行超声引导下患侧TPVB。比较两组患者术中、PACU和术后24 h PCIA芬太尼消耗量,PCIA有效按压次数,补救镇痛率,阻滞镇痛维持时间;比较两组患者不同时间点血清IL-6、MCP-1和TNF-α水平,及NPY、PGE2和β-内啡肽水平;比较两组患者术后恢复各相关指标。结果:与T组比,TP组患者术后24 h PCIA芬太尼消耗量,PCIA有效按压次数和补救镇痛率明显降低,阻滞镇痛时间明显延长;术后12 h的IL-6、MCP-1和TNF-α水平及PGE2、NPY和β-内啡肽水平均明显降低;术后低血压和心动过缓发生率,12 h DSIS睡眠干扰评分和首次下床活动时间明显降低(P<0.05)。结论:超声引导下胸横肌平面-胸神经阻滞用于乳腺癌改良根治术,较胸椎旁神经阻滞的术后镇痛效果更持久,更有利于抑制术后炎性反应,促进患者术后早期转归。Objective:To compare the effect between ultrasound-guided transversus thoracic muscle plane-pectoral nerves block(TTP-PECS) and thoracic paravertebral nerve block(TPVB) in patients underdoing modified radical mastectomy.Methods:80 patients of female,age 28~74 years old,height 151~172 cm,weighing 47~72 kg,ASA Ⅰ-Ⅱ,scheduled for elective modified radical mastectomy,were randomly divided into two groups(n=40):TTP-PECS group(group TP) and TPVB group(group T).Ultrasound-guided TTP-PECS was performed in group TP and TPVB in group T.Intraoperative,PACU and postoperative 24 h PCIA fentanyl consumption,effective PCIA pressing,rate of postoperative remedial analgesia,as well as analgesia duration were compared.The levels of IL-6,MCP-1 and TNF-α,as well as PGE2,NPY and beta-endorphins were checked at different times. The relative in-dexes of postoperative outcomes were also compared.Results:Compared with group T,the postoperative 24 h PCIAfentanyl consumption,effective PCIA pressing,and rate of postoperative remedial analgesia were decreased,and theanalgesia duration was increased. The levels of IL-6,MCP-1 and TNF-α,as well as PGE2,NPY and beta-endor-phins were reduced at postoperation 12 h. The incidence of hypotension and bradycardia,the scores of 12 h daily sleepinterference scale,and the time of first ambulation were significantly reduced in group TP(P< 0. 05).Conclusion:Compared with TPVB,ultrasound-guided TTP-PECS can provide better postoperative analgesia,better inhibit post-operative inflammatory reaction and promote early outcomes in patients underdoing modified radical mastectomy.

关 键 词：区域神经阻滞 乳腺肿瘤 镇痛 炎性反应 预后 

分 类 号：R737.9[医药卫生—肿瘤]