连续胸椎旁神经阻滞联合全身麻醉对乳腺癌根治手术患者应激反应的影响

Effect of Continuous Thoracic Paravertebral Nerve Block Combined with General Anesthesia on Stress Reaction in Breast Cancer Patients Undergoing Radical Mastectomy

目的观察连续胸椎旁神经阻滞(TPVB)联合全身麻醉对乳腺癌根治手术患者应激反应的影响。方法选择2015年10月-2018年10月收治的乳腺癌根治术患者86例进行回顾性研究。根据是否联合TPVB将所有研究对象分为联合组50例和对照组36例。记录麻醉前、切皮时、拔管时和术后24h的血糖、肾上腺素、去甲肾上腺素及多巴胺水平。于术前、术后12h和48h测定血清白介素-6(IL-6)和IL-10水平,并观察2组不良反应情况。结果与麻醉前比较,2组切皮时和拔管时的肾上腺素和去甲肾上腺素降低,术后24h升高(P<0.05);2组切皮时、拔管时及术后24h的血糖和多巴胺水平均升高(P<0.05)。联合组切皮时、拔管时及术后24h的上述各指标与对照组比较差异均有统计学意义(P<0.05)。与术前比较,2组术后12h和48h的IL-6、IL-10水平升高(P<0.05),且联合组与对照组比较差异均有统计学意义(P<0.05)。联合组不良反应发生率低于对照组(P<0.05)。结论TPVB联合全身麻醉具有减轻乳腺癌根治术患者全身应激反应和炎性反应的作用,并能减少不良反应发生。

Objective To observe effect of continuous thoracic paravertebral nerve block (TPVB) combined with general anesthesia on stress reaction in breast cancer patients undergoing radical mastectomy. Methods Clinical data of 86 breast cancer patients undergoing radical mastectomy admitted during October 2015 and October 2018 was retrospectively analyzed, and the patients were divided into combined group ( n =50) and control group ( n =36) according to whether or not combination of TPVB. Levels of blood glucose, adrenaline, norepinephrine and dopamine were recorded before anesthesia, at the time of skin incision, at the time of extubation and at 24 h after operation. Levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) were detected before operation, at 12 h and 48 h after operation, and incidence rates of adverse reactions were observed in two groups. Results Compared with those before anesthesia, levels of adrenaline and noradrenaline were decreased at the time of skin incision and extubation, and the levels were increased at 24 h after operation in two groups ( P <0.05), while levels of blood glucose and dopamine were increased at the time of skin incision and extubation, and at 24 h after operation in two groups ( P <0.05);there were significant differences in the above indexes between combined group and control group at the time of skin incision and extubation, and at 24 h after operation ( P <0.05). Compared with those before operation, IL-6 and IL-10 levels were increased at 12 h and 48 h after operation in two groups ( P <0.05), and there were significant difference in the levels between combined group and control group ( P <0.05). Incidence rate of adverse reactions in combined group was significantly lower than that in control group ( P <0.05). Conclusion TPVB combined with general anesthesia may alleviate systemic stress reaction and inflammatory reaction in breast cancer patients undergoing radical mastectomy and reduce incidence rate of adverse reactions.