超声引导前锯肌阻滞辅助全身麻醉在乳腺癌根治术患者中的应用价值

Application value of ultrasound-guided serratus anterior block assisted by general anesthesia in patients with radical mastectomy for breast cancer

目的探讨超声引导前锯肌阻滞辅助全身麻醉在乳腺癌根治术患者中的应用价值。方法采用随机数字表、单盲法将300例乳腺癌患者分为研究组和对照组,每组150例,对照组患者乳腺癌根治术中给予全身麻醉,研究组患者乳腺癌根治术中给予超声引导前锯肌阻滞辅助全身麻醉。比较两组患者的血流动力学指标[心率、平均动脉压(MAP)、经皮动脉血氧饱和度(SpO2)]、脑电双频指数(BIS)、血清疼痛因子和炎性因子[5-羟色胺(5-HT)、前列腺素E2(PGE2)、单核细胞趋化蛋白1(MCP1)、肿瘤坏死因子-α(TNF-α)]水平、麻醉镇痛相关药物的用量、麻醉相关不良反应发生情况。结果麻醉诱导后1 min、术中30 min,研究组患者的MAP均明显高于对照组(P﹤0.01),BIS均明显低于对照组(P﹤0.01)。术后24 h,研究组患者的血清5-HT、PGE2、TNF-α水平均明显低于对照组(P﹤0.01)。研究组患者术中瑞芬太尼用量、术后24 h舒芬太尼用量均明显低于对照组(P﹤0.01),麻醉相关不良反应总发生率为5.33%,低于对照组患者的14.00%(P﹤0.05)。结论超声引导前锯肌阻滞辅助全身麻醉有利于维持乳腺癌根治术患者血流动力学稳定、减少麻醉药物用量和疼痛因子的分泌。

Objective To explore the application value of ultrasound-guided serratus anterior block assisted by general anesthesia in patients with radical mastectomy for breast cancer.Method A random number table and single-blind method were used to divide 300 breast cancer patients into a study group and a control group,with 150 cases in each group.Patients in the control group were given general anesthesia during radical mastectomy for breast cancer,and patients in the study group were given ultrasound-guided serratus anterior block to assist general anesthesia during radical mastectomy.The hemodynamic indexes[heart rate,mean arterial pressure(MAP),percutaneous arterial oxygen saturation(SpO2)],bispectral index(BIS),serum pain factor and inflammatory factor levels[5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2),monocyte chemoattractant protein 1(MCP1),tumor necrosis factor-α(TNF-α)],the dosage of anesthesia and analgesia-related drugs,and the occurrence of anesthesia-related adverse reactions were compared between the two groups.Result One min after induction of anesthesia and thirty min during operation,the MAP in the study group were significantly higher than that in the control group(P<0.01),and the BIS were significantly lower than that in the control group(P<0.01).At 24 hours after operation,the serum levels of 5-HT,PGE2 and TNF-α in the study group were significantly lower than those in the control group(P<0.01).The intraoperative remifentanil dosage and 24 h postoperative sufentanil dosage in the study group were significantly lower than those in the control group(P<0.01),and the overall incidence of anesthesia-related adverse reactions was 5.33%,which was lower than 14.00%in the control group(P<0.05).Conclusion Ultrasound-guided serratus anterior block assisted by general anesthesia is beneficial to maintain hemodynamic stability,reduce the dosage of anesthetics,and reduce the secretion of pain factors in patients undergoing radical mastectomy for breast cancer.