超声引导胸壁神经阻滞在三阴性乳腺癌患者手术切除中的应用价值

Ultrasound guided chest wall nerve block for surgical resection of triple negative breast cancer

目的探讨超声引导胸壁神经阻滞在三阴性乳腺癌(TNBC)患者治疗中的应用价值。方法将180例乳腺癌患者分为常规麻醉组90例及联合神经阻滞组90例。常规麻醉组应用全身麻醉,联合神经阻滞组进行超声引导下胸壁神经阻滞,记录麻醉复苏时间,评价不同时间患者疼痛情况,分析患者术后不良情绪及生活质量,记录患者家属满意度及不良反应。结果与常规麻醉组相比,联合神经阻滞组患者恢复呼吸时间、恢复意识时间、拔出气管时间均较短,2、12、24 h疼痛评分均较低,芬太尼用量、疼痛泵按压次数均较少,汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分均较低,生活质量评分及家属满意度均较高,不良反应总发生率较低,差异均有统计学意义(P﹤0.01)。结论在手术切除治疗乳腺癌中应用超声引导胸壁神经阻滞,能够减少患者麻醉复苏时间,降低患者疼痛程度,且镇痛效果较好,改善患者术后负性情绪及生活质量,患者家属满意度较高。

Objective To explore the value of ultrasound guided chest wall nerve block for surgical resection of triple negative breast cancer(TNBC).Method A total of 180 patients with breast cancer were divided into the conventional an-esthesia group(n=90,treated with general anesthesia)and the combined nerve block group(n=90,treated with ultrasound guided chest wall nerve block);the anesthesia resuscitation time was recorded,the pain condition at different times was evaluated,the postoperative adverse emotions and quality of life were analyzed,and the family satisfaction and adverse reactions of patients were recorded.Result Compared with the conventional anesthesia group,the combined nerve block group had shorter respiratory recovery time,consciousness recovery time and tracheal extubation time,lower pain scores at 2,12,24 hours,less fentanyl dosage and pain pump compression times,lower scores on Hamilton anxiety scale(HA-MA)and Hamilton depression scale(HAMD),higher scores on quality of life and family satisfaction,with lower inci-dence of adverse reactions(P<0.01).Conclusion Ultrasound guided chest wall nerve block in surgical resection of breast cancer can reduce the time of anesthesia recovery and the intensity of pain.The analgesic effect is better,and the negative emotions and quality of life of patients are improved,with higher family satisfaction.