超声引导下前锯肌阻滞联合胸肌Ⅰ型阻滞对乳腺癌根治术患者镇痛效果、血流动力学及免疫功能的影响

Effect of ultrasound-guided Anterior Serratus Block combined with Type I thoracic block on Analgesia,Hemodynamics and immune Function in Breast Cancer patients undergoing radical Mastectomy

目的探讨乳腺癌根治术患者给予超声引导下前锯肌阻滞联合胸肌Ⅰ型阻滞对镇痛效果、血流动力学及免疫功能的影响。方法选取2020年8月至2021年9月在濮阳市妇幼保健院接受乳腺癌根治术的94例患者作为研究对象,按照随机数字表法分成观察组(47例)与对照组(47例),对照组实施胸椎旁阻滞,观察组实施超声引导下前锯肌阻滞联合胸肌Ⅰ型阻滞,比较两组镇痛效果、血流动力学、体液免疫功能及细胞免疫功能。结果术后2 h、4 h、8 h、24 h,两组视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05)。手术开始后10 min,两组平均动脉压(MAP)、心率(HR)均较术前明显降低,且观察组明显高于对照组,差异均有统计学意义(P<0.05)。术后12 h,两组免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平均明显降低,且观察组明显高于对照组,差异均有统计学意义(P<0.05)。术后12 h,两组自然杀伤细胞(NK)、CD4^(+)水平明显降低,CD8^(+)水平明显提高,差异有统计学意义(P<0.05);与对照组相比,观察组的NK、CD4^(+)水平明显更高,CD8^(+)水平明显更低,差异均有统计学意义(P<0.05)。结论乳腺癌根治术患者给予超声引导下前锯肌阻滞联合胸肌Ⅰ型阻滞,镇痛效果较好,可维持血流动力学稳定,对体液及细胞免疫功能的影响较小。

Objective To investigate the effects of ultrasound-guided block of serratus anterior combined with type I block on analgesia,hemodynamics and immune function in patients undergoing radical mastectomy.Methods A total of 94 patients who underwent radical mastectomy from August to September 2020 in Puyang maternal and child health hospital were randomly divided into observation group(47 cases)and control group(47 cases),the control group was treated with thoracic paravertebral block,and the observation group was treated with ultrasonic-guided anterior serratus block and type Ⅰ thoracic block.The analgesic effect,hemodynamics,humoral immune function and cellular immune function were compared between the two groups.Results There was no significant difference in visual analogue scale(VAS)scores(P>0.05)at 2 h,4 h,8 h and 24 h after operation between the two groups,the mean arterial pressure(MAP)and heart rate(HR)decreased significantly at 10 min after operation,the difference was statistically significant(P<0.05),but it was significantly higher in the observation group than that in the control group(P<0.05).The levels of immunoglobulin A(IgA),immunoglobulin G(IgG)and immunoglobulin M(IgM)in the two groups were significantly decreased at 12 hours after operation(P<0.05),but the levels of IgA,IgG and IgM in the observation group were significantly higher than those in the control group,there was a significant difference(P<0.05).Between the two groups,the level of natural killer cell and CD4^(+) significantly decreased at 12h postoperatively(P<0.05),and the level of CD8^(+) significantly increased(P<0.05),but compared with the control group,the level of NK and CD4^(+) in the observation group was significantly higher(P<0.05),and the level of CD8^(+) in the observation group was significantly lower(P<0.05).Conclusion Ultrasound-guided anterior serratus block combined with type Ⅰ chest block is effective in relieving pain,maintaining the stability of Hemodynamics,and has little effect on humoral and cellular immunity.