胸椎旁神经阻滞对乳腺癌患者术中应激反应和术后镇痛效果的影响

Effects of thoracic paravertebral block on intraoperative stress response and postoperative analgesia in patients with breast cancer

目的探讨胸椎旁神经阻滞(TPVB)对乳腺癌患者术中应激反应和乳腺癌术后疼痛综合征的影响。方法将60例择期行乳腺癌根治术患者随机均分为TPVB联合全身麻醉组(TPVB组)和单纯全身麻醉组(GA组)。检测麻醉诱导前(T1)、麻醉诱导后即刻(T2)、手术开始时(T3)、手术开始后30 min(T4)和出室即刻(T5)时的皮质醇(Cor)、促肾上腺皮质激素(ACTH)及血糖浓度,记录患者出麻醉复苏室即刻、术后2 h和术后12 h数字评价量表(NRS)评分,记录患者苏醒时间、手术时间、术中舒芬太尼和雷米芬太尼使用量以及不良反应发生情况。结果与GA组相比,TPVB组苏醒时间缩短,舒芬太尼和雷米芬太尼使用量减少,出麻醉复苏室即刻和术后2 h时NRS评分降低,术后恶心呕吐发生率减少(P<0.05)。TPVB组T3~T5时Cor浓度以及T4、T5时ACTH浓度较GA组降低(P<0.05);而两组不同时间点血糖浓度比较差异均无统计学意义(P>0.05)。结论TPVB可有效缓解患者术中的应激反应,减少乳腺癌术后疼痛综合征的发生。

Objective To investigate the effects of thoracic paravertebral block(TPVB) on the intraoperative stress response and post-mastectomy pain syndrome in the patients with breast cancer.Methods Sixty patients undergoing selective radical mastectomy were equally randomized into two groups of TPVB and GA.The patients in group TPVB accepted TPVB combined with general anesthesia, while those in group GA accepted general anesthesia only.The concentrations of cortisol(Cor),adrenocorticotropic hormone(ACTH) and blood glucose were detected before anesthesia(T1),immediately after anesthesia(T2),at the beginning of surgery(T3),30 minutes after surgery(T4) and immediately after leaving room(T5) in both groups.The numeric rating scale(NRS) score was recorded immediately after leaving postanesthesia care unit, 2 hours and 12 hours after surgery.The awakening time, operation time, intraoperative consumptions of sufentanil and remifentanil and postoperative adverse responses were recorded.Results Compared with group GA,the awakening time, intraoperative consumptions of sufentanil and remifentanil, NRS score immediately after leaving postanesthesia care unit and 2 hours after surgery, and incidence of postoperative nausea and vomiting were all significantly decreased in group TPVB(P<0.05).The concentrations of Cor at T3-T5 and ACTH at T4 and T5 in group TPVB were lower than those in group GA(P<0.05),while there was no statistical difference in the concentration of blood glucose at different time points between the groups of TPVB and GA(P>0.05).Conclusion TPVB could effectively attenuate the intraoperative stress response and reduce the occurrence of post-mastectomy pain syndrome.