不同麻醉方式对乳腺癌根治术患者术后镇痛效果的研究

Effect of different anesthesia methods on postoperative analgesia after radical mastectomy

目的探讨不同麻醉方式对乳腺癌根治术患者术后的镇痛效果。方法选取2021年2—5月首都医科大学附属北京同仁医院收治的90例择期进行乳腺癌根治术的患者为研究对象,根据麻醉方式不同将研究对象分为胸椎旁神经阻滞(thoracic paravertebral block,TPVB)组(30例)、前锯肌平面阻滞(serratus anterior plane block,SAPB)组(30例)和对照组(30例)。采用数字分级评分法(numerical rating scale,NRS)评价三组患者的术后疼痛相关指标,比较分析三组患者术后24h的疼痛程度、术后疼痛对日常活动的干扰程度。比较分析三组患者术后不良反应发生情况。结果TPVB组患者疼痛程度最剧烈时的NRS评分、疼痛程度最轻时的NRS评分以及剧烈疼痛时间所占百分比均显著低于对照组(P<0.05),且疼痛程度最轻时的NRS评分显著低于SAPB组(P<0.05);SAPB组患者疼痛程度最剧烈时的NRS评分显著低于对照组(P<0.05)。TPVB组患者的术后疼痛干扰床上活动的NRS评分、干扰床下活动的NRS评分均显著低于对照组和SAPB组(P<0.05);TPVB组患者的术后疼痛干扰深呼吸或咳嗽的NRS评分与对照组和SAPB组比较差异均无显著性(P>0.05)。TPVB组患者术后恶心、嗜睡、头晕发生率均显著低于对照组(P<0.05),瘙痒发生率与对照组比较差异无显著性(P>0.05)。结论TPVB可为乳腺癌根治术患者提供较好的术后镇痛效果,且不良反应较少,值得临床应用。

Objective To evaluate the postoperative analgesic effects of thoracic paravertebral block(TPVB)and serratus anterior block(SAPB)for radical mastectomy.Method 90 patients undergoing elective radical breast cancer surgery in Beijing Tongren Hospital,Capital Medical University from February 2021 to May 2021 were selected as the subjects.The subjects were divided into TPVB group(30 cases),SAPB group(30 cases)and control group(30 cases).Numerical rating Scale(NRS)was used to evaluate the postoperative pain related indicators of the three groups.The pain degree of the three groups 24 hours after surgery and the interference degree of postoperative pain to daily activities were compared and analyzed.The incidence of postoperative adverse reactions in the three groups was compared and analyzed.Result The NRS score at the most severe pain,the NRS score at the least severe pain and the percentage of severe pain time in TPVB group were significantly lower than those in control group(P<0.05),and the NRS score at the least pain was significantly lower than that in SAPB group(P<0.05).The NRS score in SAPB group was significantly lower than that in control group at the time of the most severe pain(P<0.05).The NRS score of postoperative pain interference in bed activity and NRS score of postoperative pain interference off-bed activity in TPVB group were significantly lower than those in control group and SAPB group(P<0.05).There was no significant difference in NRS score of postoperative pain interference with deep breathing or cough in TPVB group compared with control group and SAPB group(P>0.05).The incidence of postoperative nausea,drowsiness and dizziness in TPVB group was significantly lower than that in control group(P<0.05),and there was no significant difference in the incidence of pruritus between TPVB group and control group(P>0.05).Conclusion TPVB can provide better postoperative analgesia for breast cancer patients undergoing radical mastectomy,and has fewer adverse reactions,which is worthy of clinical application.