胸部神经阻滞对乳腺癌改良根治术患者术后疼痛及炎性细胞因子的影响

Effect of pectoral nerves block on postoperative pain and inflammatory cytokines in patients with breast cancer after modified radical mastectomy

目的观察胸部神经阻滞对乳腺癌改良根治术患者术后疼痛及炎性细胞因子的影响。方法选取全身麻醉下行乳腺癌改良根治术女性患者60例,随机均分为观察组和对照组。观察组采用0.5%罗哌卡因胸部神经阻滞,对照组不用胸部神经阻滞。记录术后1、4、12、24h时静息状态下VAS疼痛评分及术后需要补救镇痛率。检测术前30min(T0)、术后4h(T1)、术后24h(T2)时血清炎性细胞因子IL-6、TNF-α和超敏C反应蛋白(hs-CRP)水平。结果观察组各时点静息状态下VAS疼痛评分和补救镇痛率低于对照组(P<0.05)。T1、T2时,观察组血清hs-CRP、IL-6和TNF-α水平低于对照组(P<0.05)。结论胸部神经阻滞对全身麻醉下行乳腺癌改良根治术女性患者术后镇痛效果佳,炎性细胞因子释放少,有利于患者的术后康复。

Objective To observe the effect of pectoral nerves block on postoperative pain and inflammatory cytokines in the patients with breast cancer undergoing modified radical mastectomy.Methods Sixty female patients with breast cancer undergoing modified radical mastectomy under general anesthesia were randomly divided into two groups with 30 cases each.The pectoral nerves block of 0.5%ropivacain was performed in group A,which was not in group B as the control.VAS pain scores at rest were evaluated in the 1st,4 th,12th and 24th hour after operation.The postoperative supplemental analgesia was recorded.Serum levels of IL-6,TNF-αand hypersensitive C-reactive protein(hs-CRP)were detected at 30 minutes before operation(T0),in the 4th(T1)and 24th hour(T2)after operation.Results The VAS pain scores at rest and the cases needed for postoperative supplemental analgesia were less in group A than those in group B(P<0.05).Serum levels of IL-6,TNF-αand hs-CRP at T1 and T2 were lower in group A than those in group B(P<0.05).Conclusion Pectoral nerves block in the patients with breast cancer undergoing modified radical mastectomy under general anesthesia has the advantages of better postoperative analgesia and less release of inflammatory cytokines,which is beneficial to the postoperative rehabilitation.