降梯式前锯肌平面阻滞在乳腺癌根治手术后的镇痛效果分析  

Analgesic effects of descending ladder type serratus anterior plane block after radical breast cancer surgery

作　　者：王春侠 高芳[1] 夏伟 刘伟[1] WANG Chun-xia;GAO Fang;XIA Wei;LIU Wei(Department of Anesthesiology,Bozhou People's Hospital,Bozhou Anhui 236800,China;Department of Anesthesiology,First Affiliated Hospital of Wannan Medical College/Yijishan Hospital,Wuhu Anhui 241000,China)

机构地区：[1]亳州市人民医院麻醉科,安徽亳州236800 [2]皖南医学院第一附属医院/弋矶山医院麻醉科,安徽芜湖241000

出　　处：《局解手术学杂志》2022年第1期44-47,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：安徽省自然科学基金(180624MH305)。

摘　　要：目的探讨超声引导下降梯式前锯肌平面阻滞(SAPB)在乳腺癌根治手术后的镇痛效果及其对炎症因子、应激指标的影响。方法选择120例拟行乳腺癌根治手术的患者,按照随机数字表法将其分为观察组和对照组,每组60例。患者入室后均给予超声引导下SAPB,感觉阻滞起效后采用静吸复合喉罩全身麻醉,术后观察组采用降梯式SAPB镇痛3 d,对照组采用常规SAPB镇痛3 d。比较2组术后镇痛补救率、视觉模拟量表(VAS)评分、炎症因子水平、应激指标、术侧上肢Constant-Murley评分、神经阻滞相关并发症发生情况。结果观察组术后镇痛补救率低于对照组(P<0.05);观察组术后1 d、2 d VAS评分低于对照组(P<0.05),2组术后3 d VAS评分比较差异无统计学意义(P>0.05)。观察组术后血清肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)、皮质醇(Cor)、肾素(Rn)和促肾上腺皮质激素(ACTH)水平低于对照组(P<0.05)。观察组术后3 d术侧上肢Constant-Murley评分高于对照组(P<0.05),2组术后7 d、10 d术侧上肢Constant-Murley评分比较差异无统计学意义(P>0.05)。2组神经阻滞相关并发症总发生率比较差异无统计学意义(P>0.05)。结论超声引导下降梯式SAPB在乳腺癌根治手术后早期镇痛效果较好,能有效抑制应激反应,减少炎症反应,促进术侧上肢功能恢复,满足患者运动锻炼需求。Objective To investigate the analgesic effects of ultrasound-guided descending ladder type serratus anterior plane block(SAPB)after radical breast cancer surgery and its effects on inflammatory factors and stress indicators.Methods A total of 120 patients who were going to undergo radical breast cancer surgery were selected and divided into the observation group and the control group according to the random number table method,with 60 cases in each group.After admission,all patients were given ultrasound-guided SAPB,and the general anesthesia with static aspiration combined with laryngeal mask was used after the sensory block took effect.After surgery,the observation group was treated with descending ladder type SAPB analgesia for 3 days,while the control group was treated with conventional SAPB analgesia for 3 days.The recovery rate of postoperative analgesia,visual analogue scale(VAS)scores,levels of inflammatory factors,stress indicators,Constant-Murley scores of upper limb on the operative side,and the occurrence of complications related to nerve block of the two groups were compared.Results The recovery rate of postoperative analgesia in the observation group was lower than that in the control group(P<0.05).The VAS scores 1 day,2 days after surgery in the observation group were lower than those in the control group(P<0.05),and there was no statistically significant difference in the VAS scores 3 days after surgery between the two groups(P>0.05).The levels of serum tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),cortisol(Cor),renin(Rn)and adrenocorticotropic hormone(ACTH)after surgery in the observation group were lower than those in the control group(P<0.05).The Constant-Murley scores of upper limb on the operative side 3 days after surgery in the observation group were higher than those in the control group(P<0.05),and there was no statistically significant difference in the Constant-Murley scores of upper limb on the operative side 7 days,10 days after surgery between the two g

关 键 词：前锯肌平面阻滞 乳腺癌 罗哌卡因 降梯式 术后镇痛 炎症反应 应激 

分 类 号：R614.4[医药卫生—麻醉学]