胸神经联合前锯肌平面阻滞对保留胸肌乳腺癌根治术后患者早期康复质量的影响  

The effect of thoracic nerve combined with serratus anterior plane block on the quality of early rehabilitation of patients with breast muscle preservation after radical mastectomy

作　　者：甄书青[1] 金明[2] 陈慧霞 王华[1] 赵广平[1] 李建华[1] 王新波[1] 陈永学[1] ZHEN Shuqing;JIN Ming;CHEN Huixia;WANG Hua;ZHAO Guangping;LI Jianhua;WANG Xinbo;CHEN Yongxue(Department of Anesthesiology,Handan Central Hospital,Handan 056001,Hebei,China;Department of Anesthesiology,The Affiliated Hospital of Hebei Engineering University,Handan 056001,Hebei,China)

机构地区：[1]邯郸市中心医院麻醉科,河北邯郸056001 [2]河北工程大学附属医院麻醉科,河北邯郸056001

出　　处：《西部医学》2022年第8期1218-1221,共4页Medical Journal of West China

基　　金：河北省2020年度医学科学研究课题计划(20200484)。

摘　　要：目的探索胸神经联合前锯肌平面阻滞对保留胸肌乳腺癌根治术后患者早期恢复质量的影响。方法选取2020年9月~2021年3月在邯郸市中心医院诊断乳腺癌并拟行保留胸肌式乳腺癌根治术的117例患者。根据是否术前行胸神经联合阻滞,分为全麻组和全麻复合神经阻滞组。于术毕24、48 h记录患者恶心呕吐发生率,上肢感觉异常,腋窝疼痛评分以及镇痛补救药物的用量。术毕48 h,行40项恢复质量评分量表(QoR-40)评分。比较术前血常规与术后一天血常规中性粒细胞和淋巴细胞的比值。结果全麻复合神经阻滞组在24、48 h的恶心呕吐发生率及镇痛补救药物用量均显著低于全麻组(P<0.05),术毕24 h的上肢感觉异常,腋窝疼痛评分全麻复合神经阻滞组均显著低于全麻组(P<0.05),术后QoR-40评分全麻复合神经阻滞组显著高于全麻组(P<0.05)。术后中性粒细胞和淋巴细胞的比值全麻复合神经阻滞组较全麻组明显降低(P<0.05)。结论全麻复合胸神经阻滞可提高保留胸肌式乳腺癌根治术后患者的舒适度和满意度,有助于提高早期康复的质量。Objective To explore the effect of thoracic nerve combined with serratus anterior plane block on the quality of early postoperative recovery in patients undergoing pectoralis-sparing radical mastectomy.Methods The total 117 patients diagnosed with breast cancer and undergoing pectoral-sparing radical mastectomy in Handan Central Hospital from September 2020 to March 2021 were selected.According to whether combined thoracic nerve block was performed before surgery,the patients were divided into general anesthesia group and general anesthesia combined nerve block group.The incidence of nausea and vomiting,upper limb paresthesia,axillary pain score and the dosage of analgesic drugs were recorded 24 and 48 h after operation.Forty-eight hours after surgery,40 quality of recovery scale(QoR-40)was performed.The ratio of neutrophil to lymphocyte was compared between preoperative blood routine and one day after operation.Results The incidence of nausea and vomiting and the dosage of analgesic remedial drugs in the general anesthesia combined nerve block group at 24h and 48h were significantly lower than those in the simple general anesthesia group(P<0.05).At 24h,the upper limbs had abnormal paresthesia and axillary pain.The scores of general anesthesia combined nerve block group were significantly lower than those of simple general anesthesia group(P<0.05),and the postoperative QoR-40 score of general anesthesia combined nerve block group was significantly higher than that of general anesthesia group(P<0.05).The ratio of neutrophils to lymphocytes after the operation was significantly lower in the general anesthesia combined with nerve block group than in the simple general anesthesia group(P<0.05).Conclusion General anesthesia combined with thoracic nerve block can improve the comfort and satisfaction of patients after breast-muscle-sparing radical mastectomy,and help improve the quality of early rehabilitation.

关 键 词：前锯肌平面阻滞 乳腺癌根治术 QoR-40量表 康复质量 

分 类 号：R737.9[医药卫生—肿瘤]