胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛作用研究  

Analgesic effect of thoracic wall combined with intercostal nerve block on unilateral breast cancer after operation

作　　者：郑伟[1] 戚钰 胡正权[1] 李娜[1] 刘杰 王凯[1] ZHENG Wei;QI Yu;HU Zheng-quan;LI Na;LIU Jie;WANG Kai(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou Jiangsu 221009,China)

机构地区：[1]徐州市中心医院麻醉科,江苏徐州221009

出　　处：《局解手术学杂志》2023年第2期120-124,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81700078)。

摘　　要：目的研究胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛作用。方法选取我院拟行单侧乳腺癌保乳根治术联合腋窝淋巴结清扫术的患者128例,按照随机信封法将患者分为4组。4组患者均实施全身麻醉,A组患者予以静脉自控镇痛(PCIA),B组患者予以胸壁神经阻滞,C组患者予以肋间神经阻滞,D组患者予以胸壁联合肋间神经阻滞。比较4组患者一般资料;评估术后4 h、12 h、24 h、48 h和72 h的视觉模拟量表(VAS)评分;比较4组患者麻醉前和术后72 h疼痛介质水平[血清神经肽Y(NPY)、P物质(SP)和β-内啡肽(β-EP)]以及不良反应发生率。结果4组患者一般资料比较差异均无统计学意义(P>0.05)。VAS评分经重复测量方差分析差异均有统计学意义(P<0.05);各组术后12 h、24 h的VAS评分均高于术后4 h,术后72 h的VAS评分均低于术后4 h,术后48 h、72 h的VAS评分均低于术后12 h、24 h,术后72 h的VAS评分均低于术后48 h,且D组术后4 h、12 h、24 h、48 h、72 h的VAS评分均低于其他组,A组术后48 h、72 h的VAS评分均低于B组、C组,差异均有统计学意义(P<0.05)。4组患者术后72 h血清NPY、SP和β-EP水平均高于麻醉前(P<0.05),且组间比较,4组患者麻醉前疼痛介质水平均无统计学差异(P>0.05),术后72 h D组NPY、SP和β-EP水平均低于其余3组(P<0.05);A组术后72 h疼痛介质水平均低于B组、C组(P<0.05),B组和C组术后72 h疼痛介质水平差异均无统计学意义(P>0.05)。4组患者均无神经阻滞相关并发症,不良反应发生率比较差异无统计学意义(P>0.05)。结论胸壁联合肋间神经阻滞对单侧乳腺癌术后的镇痛效果较PCIA、单纯胸壁神经阻滞或肋间神经阻滞更好,可更有效地控制疼痛介质水平升高,且安全性良好。Objective To study the analgesic effect of thoracic wall combined with intercostal nerve block on unilateral breast cancer after operation.Methods A total of 128 patients who intended to undergo breast-conserving radical mastectomy combined with axillary lymph node dissection for unilateral breast cancer in our hospital were enrolled and divided into 4 groups according to the random envelope method.All patients in the 4 groups received general anesthesia,patients in group A were given patient-controlled intravenous analgesia(PCIA),patients in group B were given thoracic wall nerve block,patients in group C were given intercostal nerve block,and patients in group D were given thoracic wall combined with intercostal nerve block.The general data of 4 groups was compared.Visual analogue scale(VAS)scores 4 hours,12 hours,24 hours,48 hours and 72 hours after operation were compared among the four groups.The levels of pain mediators[serum neuropeptide Y(NPY),substance P(SP)andβ-endorphin(β-EP)]before analgesia and 72 hours after operation,and the incidences of adverse reactions were compared among the four groups.Results There was no statistically significant difference in the general data among the four groups(P>0.05).The differences in VAS scores were statistically significant by repeated measurement analysis of variance(P<0.05).The VAS scores in each group 12 hours and 24 hours after operation were higher than those 4 hours after operation,the VAS scores in each group 72 hours after operation were lower than those 4 hours after operation,the VAS scores in each group 48 hours and 72 hours after operation were lower than those 12 hours and 24 hours after operation,and the VAS scores in each group 72 hours after operation were lower than those 48 hours after operation;while the VAS scores in group D 4 hours,12 hours,24 hours,48 hours and 72 hours after operation were lower than those in other groups,the VAS scores in group A 48 hours,72 hours after operation were lower than those in group B and group C,with statistica

关 键 词：静脉自控镇痛 胸壁神经阻滞 肋间神经阻滞 乳腺癌 术后镇痛 疼痛介质 

分 类 号：R737.9[医药卫生—肿瘤] R614.2[医药卫生—临床医学]