胸神经阻滞、竖脊肌平面阻滞对乳腺癌患者术后疼痛程度及术后康复指标的影响

Effects of thoracic nerve block and erector spinae plane block on postoperative pain degree and postoperative rehabilitation indexes in patients with breast cancer

目的探讨胸神经阻滞、竖脊肌平面阻滞对乳腺癌患者术后疼痛程度及术后康复指标的影响。方法选择2018年1月至2020年6月收治的100例乳腺癌患者作为研究对象,以简单随机化法将其分为对照组与试验组,每组50例。所有患者进入手术室后行常规检测及麻醉诱导等,对照组实施胸神经阻滞,试验组实施竖脊肌平面阻滞。比较两组患者的手术相关情况、术后不同时间点的疼痛程度、术后康复指标以及术后并发症发生情况。结果试验组的神经阻滞操作时间、阻滞起效时间、术后PCA首次按压时间短于对照组,阻滞平面上升节段数大于对照组,术后24 h内PCA有效按压次数多于对照组(P<0.05);两组的术中瑞芬太尼用量无明显差异(P>0.05)。两组术后2、48 h的VAS评分无明显差异(P>0.05);试验组术后4、8、12、24 h的VAS评分低于对照组(P<0.05)。试验组的首次肛门排气时间、首次下床活动时间、术后住院时间短于对照组(P<0.05)。两组的恶心、呕吐、皮肤瘙痒发生率无明显差异(P>0.05)。结论与胸神经阻滞比较,竖脊肌平面阻滞可以改善乳腺癌患者的手术相关情况,缓解术后疼痛程度,促进术后康复,且安全性较高。

Objective To investigate the effects of thoracic nerve block and erector spinae plane block on postoperative pain degree and postoperative rehabilitation indexes in patients with breast cancer.Methods From January 2018 to June 2020,100 patients with breast cancer were selected as the research objects.The patients were divided into control group and experimental group by simple randomization method,with 50 cases in each group.After entering the operating room,all patients underwent routine detection and anesthesia induction.The control group implemented thoracic nerve block and the experimental group implemented erector spinae plane block.The operation related condition,pain degree at different time points,postoperative rehabilitation indexes and occurrence of postoperative complications were compared between the two groups.Results The operation time of nerve block,the onset time of block and the first press time of PCA after operation in the experimental group were shorter than those in the control group,the number of ascending segments of block plane was greater than that in the control group,and the number of effective press times of PCA within 24 h after operation was more than that in the control group(P<0.05);there was no significant difference in the intraoperative remifentanil dosage between the two groups(P>0.05).There was no significant difference in the VAS score at 2 and 48 h after operation between the two groups(P>0.05);the VAS score at 4,8,12 and 24 h after operation in the experimental group was lower than that in the control group(P<0.05).The first anal exhaust time,the first out of bed activity time and the postoperative hospital stay in the experimental group were shorter than those in the control group(P<0.05).There were no significant differences in the incidences of nausea,vomiting and skin pruritus between the two groups(P>0.05).Conclusion Compared with thoracic nerve block,erector spinae plane block can improve the operation condition of patients with breast cancer,relieve postoperative pain degree and promote postoperative rehabilitation,with higher safety.