不同神经阻滞方案对乳腺癌改良根治术后镇痛效果的影响

Influence of different kinds of nerve block schemes onanalgesic effect after modified radical mastectomy for breast cancer

目的探讨胸椎旁神经(TPVN)阻滞和胸神经Ⅱ(Pectoral NervesⅡ,PecsⅡ)阻滞对乳腺癌改良根治术后镇痛及阻滞效果的影响。方法选取平煤神马医疗集团总医院2016年8月至2019年1月收治的乳腺癌病人共130例,均行改良根治术治疗;入选病人以随机抽签法分为TPVN组(65例)和PecsⅡ组(65例),其中TPVN组在超声引导下采用TPVN阻滞,而PecsⅡ组则在超声引导下采用PecsⅡ阻滞;比较两组术后VAS疼痛评分、Ramsay镇静评分、镇痛效果持续时间、术后24 h舒芬太尼使用量及局麻药物扩散区域。结果PecsⅡ组术后2 h、6 h、12 h、24 h VAS疼痛评分分别为(0.52±0.10)分,(1.90±0.52)分,(3.21±0.94)分,(2.60±0.82)分,均显著低于TPVN组为(0.94±0.22)分,(2.35±0.69)分,(3.94±1.22)分,(3.23±1.09)分(P<0.05);两组术后Ramsay镇静评分组间比较差异无统计学意义(P>0.05);PecsⅡ组镇痛效果持续时间和术后24 h舒芬太尼使用量分别为(342.70±62.62)min,(6.96±1.02)μg,均显著优于TPVN组的(215.96±46.17)min,(10.51±1.49)μg(P<0.05);PecsⅡ组T2扩散比例显著高于TPVN组(P<0.05);同时两组T3、T4、T5及T6扩散比例组间比较差异无统计学意义(P>0.05)。结论与TPVN阻滞相比,行乳腺癌改良根治术病人采用PecsⅡ阻滞方案应能够有效减轻术后疼痛,增加镇痛效果持续时间,降低阿片类药物用量,并有助于获得更为完善阻滞效果。

Objective To investigate the influence of TPVN and PecsⅡfor nerve block schemes on analgesia and blocking effect of patients after modified radical mastectomy.To explore the effects of thoracic paravertebral nerve(TPVN)block and thoracic nerveⅡ(Pectoral NervesⅡ,PecsⅡ)block on the analgesia and block effect after modified radical mastectomy for breast cancer.Methods A total of 130 patients with breast cancer admitted to General Hospital of Pingmei Shenma Medical Group from August2016 to January 2019 were chosen,and all of them were treated with modified radical mastectomy.The patients wererandomly divided into TPVN group(65 patients)and PecsⅡgroup(65 patients),of which the TPVN group used TPVN block under ultrasound guidance,while the PecsⅡgroup used PecsⅡblock under ultrasound guidance.The VAS score and Ramsay sedation score after operation,duration of analgesia,the usage of sufentanil in 24 hours after operation and the diffusion region of local anesthetics of both groups were compared.Results The VAS scores of the PecsⅡgroup at 2 h,6 h,12 h and 24 h after operation were(0.52±0.10)points,(1.90±0.52)points,(3.21±0.94)points,(2.60±0.82)points,which were significantly lower than those in the TPVN group:(0.94±0.22)points,(2.35±0.69)points,(3.94±1.22)points,(3.23±1.09)points(P<0.05).There was no significant difference in the Ramsay sedation score after operation between the two groups(P>0.05).The duration of analgesic effect in the PecsⅡgroup and the amount of sufentanil used at 24 h after surgery were(342.70±62.62)min and(6.96±1.02)μg,respectively,which were significantly better than those in the TPVN group(215.96±46.17)min,(10.51±1.49)μg(P<0.05);The T2 diffusion ratio of the PecsⅡgroup was significantly higher than that of the TPVN group(P<0.05);at the same time,there was no significant difference in the T3,T4,T5 and T6 diffusion ratios between the two groups(P>0.05).Conclusion Compared with TPVN,PecsⅡfor ultrasound-guided nerve block schemes in the treatment of patients after radical mastectomy can efficiently relieve pain degree,prolong duration of analgesia,reduce opioid dosage and be helpful to achieve more perfect blockade.