超声引导下胸神经阻滞和连续胸椎旁神经阻滞对乳腺癌术后患者恢复的影响

Effect of ultrasound-guided thoracic nerve block and continuous thoracic paravertebral nerve block on postoperative recovery of breast cancer patients

目的比较超声引导下胸神经阻滞和连续胸椎旁神经阻滞对乳腺癌术后患者恢复的影响。方法对2017年3月-2018年12月在笔者所在医院接受治疗的190例乳腺癌患者进行临床研究,根据随机数表法将患者分为对照组和试验组,对照组采用超声下连续胸椎旁神经阻滞,试验组采用超声引导下胸神经阻滞,统计手术前(T0)及手术后12 h(T1)、24 h(T2)和48 h(T3)两组患者手术治疗前后神经病理性疼痛情况、静息和咳嗽状态下的视觉模拟评分法(VAS)以及手术后两组患者不良反应的发生情况。结果与对照组相比,试验组在T3时的乳房痛病例数明显减少(P<0.05),而肋间神经痛病例数在术后T2和T3均明显减少(P<0.05),两组的神经瘤性痛病例数治疗前后无统计学差异(P>0.05)。与对照组相比,试验组手术后T1、T2和T3的VAS评分均明显下降(P<0.05)。与对照组相比,试验组的术后不良反应发生情况明显减少(P<0.05)。T0时两组的VO2max和VEmax没有统计学差异(P>0.05)。与对照组相比,T1、T2和T3时试验组的VO2max和VEmax明显提高(P<0.05)。结论与连续胸椎旁神经阻滞相比,胸神经阻滞的术后镇痛效果更佳且不良反应发生率明显降低,值得在乳腺癌根治术治疗中推广应用。

Objective To compare the effect of ultrasound-guided thoracic nerve block and continuous thoracic paravertebral nerve block on postoperative recovery of patients with breast cancer. Methods A clinical study was conducted on 190 cases of breast cancer patients treated in our hospital from March 2017 to December 2018.According to the random number table method,patients were divided into control group and experimental group. Neuropathic pain,VAS scores in resting and coughing states before and after surgery(T0) and 12 h(T1),24 h(T2) and 48 h(T3),and adverse reactions after surgery in the two groups were analyzed. Results Compared with the control group,the number of cases of breast pain in the experimental group was significantly reduced at T3(P<0.05),while the number of cases of intercostal neuralgia was significantly reduced at T2 and T3(P<0.05),and there was no statistical difference between the two groups before and after the treatment(P>0.05). Compared with the control group,the VAS scores of the experimental group were significantly decreased at T1、T2 and T3(P <0.05).Compared with the control group,the incidence of postoperative adverse reactions in the experimental group was significantly reduced(P<0.05). There was no statistically significant difference in VO2max and VEmax between the two groups at T0(P >0.05). Compared with the control group,VO2max and VEmax at T1,T2 and T3 were significantly increased(P<0.05). Conclusion Compared with continuous thoracic paravertebral nerve block,thoracic nerve block has a better analgesic effect and a significantly lower incidence of adverse reactions.