超声引导下前锯肌平面阻滞对乳腺癌根治术患者应激反应及血清CA153、NSE水平的影响  

Effects of ultrasound-guided serratus plane block on stress response,serum CA153 and NSE levels in patients undergoing radical mastectomy

作　　者：黄杰[1] 陈治鹏 黄坤 郭青 黄柯冰 Huang Jie;Chen Zhipeng;Huang Kun;Guo Qing;Huang Kebing(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市中心医院麻醉科,汉中723000

出　　处：《中华内分泌外科杂志（中英文）》2024年第5期656-660,共5页Chinese Journal of Endocrine Surgery

基　　金：陕西省重点研发计划项目(2017SF-074)。

摘　　要：目的探讨超声引导下前锯肌平面阻滞(ultrasound-guided serratus plane block,US-SPB)对乳腺癌根治术患者应激反应及血清糖类抗原153(cancer antigen 153,CA153)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平的影响。方法选取2022年2月至2024年2月于汉中市中心医院进行收治的110例拟行乳腺癌手术的患者作为研究对象,依据随机数字表原则,将110例患者分为US-SPB组和对照组,每组各55例,分别给予US-SPB及常规麻醉,观察两组应激指标、肿瘤指标、疼痛及镇静情况、手术相关指标差异。结果术后24 h,US-SPB组血清皮质醇(cortisol,Cor)、肾上腺素(epinephrine,EPI)和去甲肾上腺素(noradrenaline,NE)显著低于对照组(t=4.69、5.07、5.38,P<0.05);US-SPB组血清CA153、NSE水平显著低于对照组(t=2.15、2.04,P<0.05);术后6、12、24 h,US-SPB组视觉模拟评分法(visual analogue scales,VAS)评分、Ramsay镇静评分(ramsay sedation score,RSS)显著低于对照组(VAS:F组间=17.67,P组间<0.05;F时间=15.58,P时间<0.05;F交互=0.96,P交互>0.05;RSS:F组间=12.77,P组间<0.05;F时间=10.88,P时间<0.05;F交互=0.32,P交互>0.05);US-SPB组术中瑞芬太尼使用量、术后舒芬太尼用量显著低于对照组(t=1.99,P<0.05)。结论US-SPB不仅能减少乳腺癌根治术患者应激反应,同时对于肿瘤标志物水平的降低同样有积极作用,疼痛管理效果更佳。ObjectiveTo investigate the effects of ultrasound-guided serratus plane block(US-SPB)on stress response,serum cancer antigen 153(CA153)and neuron-specific enolase(NSE)levels in patients undergoing radical mastectomy.MethodsA total of 110 patients with radical mastectomy who were admitted to our hospital from Feb.2022 to Feb.2024 were chosen and separated into US-SPB group(n=55,US-SPB)and control group(n=55,conventional anesthesia)by the principle of random number table.The differences of stress index,tumor index,pain,sedation,and operation related index were observed between the two groups.Results24h after operation,serum cortisol(Cor),epinephrine(EPI)and noradrenaline(NE)in US-SPB group were significantly lower than those in control group(t=4.69,5.07,5.38,P<0.05);The levels of serum CA153 and NSE in US-SPB group were significantly lower(t=2.15,2.04,P<0.05);The visual analogue scales(VAS)scores and Ramsay sedation score(RSS)scores in US-SPB group were significantly lower at 6h,12h and 24h after surgery(VAS:F inter-group=17.67,P inter-group<0.05;F time=15.58,P time<0.05;F interaction=0.96,P interaction>0.05;RSS:F inter-group=12.77,P inter-group<0.05;F time=10.88,P time<0.05;F interaction=0.32,P interaction>0.05);The intraoperative dosage of remifentanil and the postoperative dosage of sufentanil in US-SPB group were significantly lower(t=1.99,P<0.05).ConclusionUS-SPB can not only reduce the stress response of patients undergoing radical mastectomy,but also have a positive effect on the reduction of tumor marker levels,and the pain management effect is better.

关 键 词：乳腺癌 根治术 超声引导下前锯肌平面阻滞 糖类抗原153 神经元特异性烯醇化酶 应激 

分 类 号：R737.9[医药卫生—肿瘤] R614[医药卫生—临床医学]