超声引导竖脊肌间隙阻滞与胸椎椎旁神经阻滞对乳腺癌手术患者疼痛影响

Comparative study of ultrasound⁃guided erector spinae plane block and thoracic paraver⁃tebral block on pain and inflammatory factors in patients undergoing breast cancer sur⁃gery

目的探讨超声引导竖脊肌间隙阻滞与胸椎椎旁神经阻滞对乳腺癌手术患者疼痛及炎症因子的影响。方法选取2019年1月至2021年6月河南省安阳市人民医院择期行单侧乳腺癌根治术治疗的女性患者80例,随机分为ESPB组与TPVB组,各40例,分别行超声引导竖脊肌间隙阻滞与超声引导胸椎椎旁神经阻滞,观察患者手术时间、术中出血量、丙泊酚及瑞芬太尼用量,术后疼痛程度(VAS),术后24 h内镇痛泵按压次数,术前和术后24 h时的血清肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)变化。结果两组患者手术时间、术中出血量、丙泊酚及瑞芬太尼用量比较差异无统计学意义(P>0.05);TPVB组术后2、6、12、24 h、48 h时静息和咳嗽状态下的VAS评分低于ESPB组,差异有统计学意义(静息状态t=5.076、6.821、3.716、4.205、6.105,咳嗽状态t=5.512、3.566、3.448、3.724 h、7.272,P<0.05);TPVB组术后24 h内镇痛泵按压次数少于ESPB组,差异有统计学意义(t=7.255,P<0.05);两组术前TNF-α、IL-6、IL-8水平比较差异无统计学意义(P>0.05),术后较术前有所升高,且ESPB组高于TPBV组,差异有统计学意义(t=3.583、5.108、3.468,P<0.05)。结论超声引导竖脊肌间隙阻滞应用于乳腺癌手术能够有效降低患者的疼痛程度及炎症因子水平,具有更佳的术后镇痛效果及抑制围术期炎症反应效果,可以作为优选麻醉方案。

Objective To investigate the effects of ultrasound⁃guided erector spinae plane block and thoracic paravertebral block on pain and inflammatory factors in patients undergoing breast cancer surgery.Methods From January 2019 to June 2021 in Anyang People's Hospital,80 patients with radical mastectomy for breast cancer were randomly divided into the ESPB group and the TPVB group,40 cases in each groupo.Ultrasound⁃guided erector spinae plane block and ultrasound⁃guided thoracic paravertebral block were performed before operation.The operation time,intraoperative blood loss,dosage of propofol and remifentanil,postoperative pain level(VAS),pressing times of analgesic pump within 24 hours after operation,serum tumor levels before operation and 24 hours after operation were observed.The levels of serum tumor necrosis factorα(TNF⁃α),interleukin⁃6(IL⁃6)and interleukin⁃8(IL⁃8)at 24 h before and after surgery were measured and analyzed.Results There was no significant difference between the two groups in operation time,intraoperative blood loss,propofol and remifentanil dosage(P>0.05).The VAS scores in resting and cough state at 2 h,6 h,12 h,24 h and 48 h postoperatively was lower in the TPVB group than those in the ESPB group(resting state t=5.076,6.821,3.716,4.205,6.105,cough state t=5.512,3.566,3.448,3.724 h,7.272,P<0.05).The number of analgesia pump pressure in the TPVB group were lower than that in the ESPB group within 24 h after operation(t=7.255,P<0.05).There was no significant difference in the preoperative levels of TNF⁃α,IL⁃6 and IL⁃8 between the two groups(P>0.05),but they were higher after operation than before operation,and the ESPB group was higher than the TPBV group,the difference was statistically significant Significance(t=3.583,5.108,3.468,P<0.05).Conclusion Ultrasound⁃guided erector spinae space block applied to breast cancer surgery can effectively reduce pain and inflammatory factor levels of patients,have better postoperative analgesic effect and inhibit perioperative inflammatory response,and can be used as an optimal anesthesia scheme.