超声引导下胸神经阻滞在乳腺癌手术患者中的应用

Application of Ultrasound-Guided Thoracic Nerve Block in Patients with Breast Cancer Surgery

目的探讨超声引导下胸神经阻滞对乳腺癌手术患者免疫球蛋白及炎症指标的影响。方法选取乳腺癌手术患者80例,采用随机数字奇偶法进行分组,奇数组为观察组,偶数组为对照组,各40例。对照组采用胸椎旁神经阻滞麻醉,观察组采用超声引导下胸神经阻滞麻醉,比较2组手术时间;麻醉前30 min(T0)、手术结束时(T1)、术后24 h(T2)时的免疫指标、炎症指标水平。结果2组手术时间比较,差异无统计学意义(P>0.05);观察组与对照组T1时免疫球蛋白A(IgA)[(1.75±0.34)、(1.47±0.35)]g·L^(-1)、免疫球蛋白G(IgG)[(10.00±2.12)、(9.62±1.90)]g·L^(-1)水平较T0时IgA[(1.82±0.43)、(1.80±0.42)]g·L^(-1)、IgG[(10.21±2.42)、(10.20±2.46)]g·L^(-1)下降,在T2时回升,且观察组变化幅度小于对照组,组别、时点、组别·时点比较,差异均有统计学意义(P<0.05);T1时2组白细胞介素-6(IL-6)[(102.24±6.80)、(115.56±6.47)]ng·L^(-1)、白细胞介素-10(IL^(-1)0)[(7.60±1.36)、(9.81±1.12)]ng·L^(-1)、肿瘤坏死因子-α(TNF-α)[(2.27±0.51)、(3.85±0.52)]μg·L^(-1)水平、T2时2组IL-6[(145.60±7.28)、(154.98±7.59)]ng·L^(-1)、IL^(-1)0[(10.60±2.71)、(14.52±2.83)]ng·L^(-1)、TNF-α[(4.32±0.35)、(5.20±0.38)]μg·L^(-1)水平均较T0时IL-6[(54.60±7.98)、(54.82±8.01)]ng·L^(-1)、IL^(-1)0[(2.38±0.22)、(2.39±0.25)]ng·L^(-1)、TNF-α[(1.03±0.60)、(1.05±0.42)]μg·L^(-1)升高,但观察组T_(1)、T_(2)时IL-6、IL^(-1)0、TNF-α水平低于对照组,组别、时点、组别·时点比较,差异均有统计学意义(P<0.05)。结论乳腺癌手术中在超声引导下行胸神经阻滞,可有效减轻手术对患者免疫系统的影响,降低炎症水平利于预后。

Objective This study is to investigate the effect of ultrasound-guided thoracic nerve block on immunoglobulin and inflammatory indexes in patients with breast cancer.Methods 80 cases of patients with breast cancer surgery were selected and divided into groups according to the random number parity method,the odd group was included in the observation group,and the even group was included in the control group,40 cases in each group.The control group was treated with thoracic paravertebral nerve block anesthesia,and the observation group was treated with ultrasound-guided thoracic nerve block anesthesia.Compared the operation time of the two groups;the immune index and inflammation index levels of the two groups were compared 30 minutes before anesthesia(T0),at the end of the operation(T1),and 24 hours after the operation(T2).Results The operation time of the two groups was compared,the difference was not statistically significant(P>0.05);the levels of immunoglobulin A(IgA)[(1.75±0.34),(1.47±0.35)]g·L^(-1) andimmunoglobulin G(IgG)[(10.00±2.12),(9.62±1.90)]g·L^(-1) in both groups at T1 were decreased than IgA[(1.82±0.43),(1.80±0.42)]g·L^(-1) and IgG[(10.21±2.42),(10.20±2.46)]g·L^(-1) at T0,and were increased at T2,and the change range of the observation group was smaller than that of the control group,compared between groups,time points,and group·time points,the difference was statistically significant(P<0.05);the levels of IL-6[(102.24±6.80),(115.56±6.47)]ng·L^(-1),IL^(-1)0[(7.60±1.36),(9.81±1.12)]ng·L^(-1),TNF-α[(2.27±0.51),(3.85±0.52)]μg·L^(-1) in both groups at T1,IL-6[(145.60±7.28),(154.98±7.59)]ng·L^(-1),IL^(-1)0[(10.60±2.71),(14.52±2.83)]ng·L^(-1) and TNF-α[(4.32±0.35),(5.20±0.38)]μg·L^(-1) in the two groups at T2 were all increased than IL-6[(54.60±7.98),(54.82±8.01)]ng·L^(-1),IL^(-1)0[(2.38±0.22),(2.39±0.25)]ng·L^(-1) and TNF-α[(1.03±0.60),(1.05±0.42)]μg·L^(-1) at T0,but the levels of IL-6,IL^(-1)0 and TNF-αin the observation group at T_(1) and T_(2) were lower than those in the control group,compared between groups,time points,and group·time points,the differences were statistically significant(P<0.05).Conclusion Undergoing ultrasound-guided thoracic nerve block during breast cancer surgery can effectively reduce the impact of this surgery on the patient’s immune system,reduce the level of inflammation,and is beneficial to the prognosis.