胸神经Ⅱ阻滞和胸椎旁神经阻滞对改良乳腺癌根治术的镇痛效果比较  

Comparison of analgesic effect of pectoral nerve Ⅱ block and thoracic paravertebral nerve block in modified radical mastectomy

作　　者：郑重[1] 张立东[1] 祁富伟[1] 何静[1] 杨广宇[1] ZHENG Zhong;ZHANG Lidong;QI Fuwei;HE Jing;YANG Guangyu(Department of Anesthesiology,First People’s Hospital of Taicang City,Taicang Jiangsu 215400,China)

机构地区：[1]太仓市第一人民医院麻醉科,江苏太仓215400

出　　处：《临床与病理杂志》2022年第2期352-358,共7页Journal of Clinical and Pathological Research

摘　　要：目的:比较胸神经Ⅱ(pectoral nervesⅡ,PecsⅡ)阻滞与胸椎旁神经(thoracic paravertebral nerve,TPVN)阻滞改良乳腺癌根治术围手术期的镇痛效果及对炎性细胞因子、术后早期恢复质量的影响。方法:选取2019年3月至2021年3月于江苏省太仓市第一人民医院择期行改良乳腺癌根治术的80例患者为研究对象,随机分为PecsⅡ组与TPVN组,每组40例,并以同期20例健康体检者作对照组。PecsⅡ组采用PecsⅡ阻滞,TPVN组采用TPVN阻滞。比较两组术后0.5、2、4、6、12、24、48 h时疼痛视觉模拟量表(Visual Analogue Scale,VAS)及镇痛持续时间、术后24 h内舒芬太尼用量,检测术前、术后1、3 d时血清白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)水平,比较术后1、2、3d时40项恢复质量评分量表(40-item Quality of Recovery Questionnaire,QoR-40)评分,观察术后不良反应。结果:与TPVN组相比,PecsⅡ组在术后2~24h时的VAS评分均明显更低,镇痛持续时间更长,术后24 h内舒芬太尼用量更少(P<0.05)。PecsⅡ组在术后1、3 d时的血清IL-6、TNF-α水平均明显低于TPVN组(P<0.05)。PecsⅡ组QoR-40评分在术后1~3 d均明显高于TPVN组(P<0.05)。两组术后不良反应总发生率比较无明显差异(17.50%vs25.00%,P>0.05)。结论:PecsⅡ阻滞相较于TPVN阻滞对改良乳腺癌根治术患者的术后镇痛效果更好,还可有效降低炎性细胞因子水平,提升术后早期恢复质量。Objective:To compare effects of pectoral nerves Ⅱ(Pecs Ⅱ) block and thoracic paravertebral nerve(TPVN)block on perioperative analgesia,inflammatory cytokines and quality of early postoperative recovery after modified radical mastectomy.Methods:A total of 80 patients scheduled for modified radical mastectomy in our hospital from March 2019 to March 2021 were randomly divided into a Pecs Ⅱ group and a TPVN group;40 cases in each group, meanwhile, 20 healthy people in the same period served as the control group.Pecs Ⅱ block was used in the Pecs Ⅱ group and TPVN block was used in the TPVN group.The Visual Analogue Scale(VAS)at 0.5,2,4,6,12,24,48 h after the operation,and duration of analgesia,sufentanil dosage within 24 h after the operation were compared between the 2 groups.The serum interleukin-6(IL-6) and tumor necrosis factor-a(TNF-α) were detected before operation,1 and 3 d after the operation,and the scores of 40-item Quality of Recovery Questionnaire(QoR-40) were compared at 1,2 and 3 d after the operation and the adverse reactions were observed.Results:Compared with the TPVN group,the VAS score of the Pecs Ⅱ group was significantly lower at 2-24 hours after the operation,the duration of analgesia was longer;and sufentanil dosage was less in24 h after the operation(P<0.05).The levels of IL-6 and TNF-α of the Pecs Ⅱ group at 1 and 3 d after the operation were significantly lower than those of the TPVN group(P<0.05).The QoR-40 score at 1-3 d in Pecs Ⅱ group was significantly higher than that in the TPVN group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the 2 groups(17.50% vs 25.00%,P>0.05).Conclusion:Compared with TPVN block,Pecs Ⅱ block has better postoperative analgesia effect in patients with modified radical mastectomy,and can effectively reduce the level of inflammatory factors and improve the quality of early postoperative recovery.

关 键 词：胸神经Ⅱ阻滞 胸椎旁神经阻滞 镇痛 炎性细胞因子 术后恢复 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]