精准麻醉策略对乳腺癌术后疼痛及炎性因子的影响

Effects of Precision Anesthesia on Postoperative Pain and Inflammatory Factors in Patient Undergoing Breast Cancer Surgery

目的评价精准麻醉策略下优化围术期管理对乳腺癌术后疼痛及炎性因子的影响。方法选择拟全身麻醉下行单侧乳腺癌改良根治术的女性患者64例,采用随机数字表法,将其分为精准麻醉组(P组)和传统麻醉组(R组),每组32例。P组予精准化麻醉管理,包括抗焦虑、多模式镇痛、抗炎及术后康复治疗;R组予传统的经验式麻醉管理。记录并比较2组术中瑞芬太尼和丙泊酚的用量、术后48 h镇痛泵有效按压次数及住院总费用,术后1 h(T_(1))、6 h(T_(2))、12 h(T_(3))、1 d(T_(4))、2 d(T_(5))、3 d(T_(6))时静息及咳嗽的疼痛视觉模拟评分(VAS评分),术前(T_(0))、T_(1)、T_(4)、T_(5)及T_(6)时静脉血IL-6及TNF-α质量浓度,术后嗜睡、恶心呕吐、穿刺并发症等不良反应发生情况。结果与R组比较,P组术中丙泊酚、瑞芬太尼用量及术后48 h镇痛泵按压次数更少,在T_(1)—T_(5)时点VAS评分更低(P<0.05);在T_(1)、T_(4)及T_(5)时IL-6及TNF-α质量浓度下降(P<0.05)。R组术后出现恶心呕吐6例,2组均未见其他不良反应。结论围术期采用精准麻醉策略可有效缓解乳腺癌患者术后疼痛,并抑制炎症因子的释放。

Objective To evaluate the effects of optimized perioperative management under precision anesthesia strategy on postoperative pain and inflammatory factors in patient undergoing breast cancer surgery.Methods A total of 64 female patients scheduled for unilateral radical mastectomy were randomly divided into two groups,with 32 patients in each group.The precision anesthesia group(group P)received precise anesthesia management,including anti-anxiety,multimodal analgesia,anti-inflammation,and postoperative rehabilitation.The routine anesthesia group(group R)was given traditional anesthetic management based on clinical experience.The consumption of remifentanil and propofol during operation and the effective pressing times of analgesic pump within 48 h after operation were compared between the two groups.Visual analogue scale(VAS)scores at rest and on cough were recorded at 1 h(T_(1))、6 h(T_(2))、12 h(T_(3))、1 d(T_(4))、2 d(T_(5))、3 d(T_(6))after operation.The concentrations of IL-6 and TNF-αin venous blood were measured before surgery(T0)and at T_(1),T_(4),T_(5) and T_(6) after operation.Postoperative drowsiness,nausea and vomiting(PONV),puncture complications,and other adverse reactions were observed in both groups.Results Compared with group R,precise anesthesia management led to significant decrease in consumption of remifentanil and propofol during operation,effective pressing times of analgesic pump within 48 h after operation,VAS scores at T_(1-5),and levels of IL-6 and TNF-αat T_(1),T_(4) and T_(5)(P<0.05).Six patients in group R had PONV after operation.However,no other adverse reactions were observed in both groups.Conclusion Precision anesthesia strategy can effectively relieve postoperative pain and inhibit the release of inflammatory factors in patients undergoing breast cancer surgery.