超声引导下前锯肌平面阻滞对乳腺癌改良根治术患者血清疼痛介质、血流动力学及免疫功能的影响

Effect of Ultrasound-Guided Anterior Serratus Plane Block on Serum Pain Mediators,Hemodynamics and Immune Function in Patients Undergoing Modified Radical Mastectomy for Breast Cancer

目的:探讨超声引导下前锯肌平面(SP)阻滞对乳腺癌改良根治术患者血流动力学、血清疼痛介质、免疫功能的影响。方法:选择2020年9月-2022年5月期间我院收治的120例乳腺癌改良根治术患者,采用随机双盲对照原则将患者分为对照组和研究组,各为60例。对照组患者接受常规麻醉,研究组患者在常规麻醉基础上接受超声引导下SP阻滞。观察两组患者的镇静镇痛效果,对比两组患者疼痛介质、血流动力学及免疫功能的变化情况,记录两组围术期间不良反应发生情况。结果:研究组手术开始后10 min、术毕心率(HR)、平均动脉压(MAP)高于对照组(P<0.05)。研究组术后24 h CD8+低于对照组,CD3+、CD4+、CD4+/CD8+高于对照组(P<0.05)。研究组术后24 h神经肽Y(NPY)、前列腺素E2(PGE2)、P物质(SP)低于对照组(P<0.05)。研究组术后24 h疼痛视觉模拟评分(VAS)评分低于对照组,Ramsay镇静评分高于对照组(P<0.05)。两组不良反应发生率对比,无统计学差异(P>0.05)。结论:超声引导下SP阻滞可加强乳腺癌改良根治术患者的镇静镇痛效果,维持血流动力学稳定,降低血清疼痛介质,减轻免疫抑制。

Objective:T investigate the effect of ultrasound-guided anterior serratus plane (SP) block on hemodynamics,serum pain mediators and immune function in patients undergoing modified radical mastectomy for breast cancer.Methods:120 patients with breast cancer who were treated by modified radical mastectomy in our hospital from September 2020 to May 2022 were selected.The patients were divided into the control group and the study group by the principle of random double-blind control,with 60 patients each.Patients in the control group received routine anesthesia,and patients in the study group received ultrasound-guided SP block on the basis of routine anesthesia.The sedative and analgesic effects of the two groups of patients were observed,the changes of pain media,hemodynamics and immune function of the two groups of patients were compared,and the occurrence of adverse reactions during the perioperative period of the two groups were recorded.Results:The heart rate (HR) and mean arterial pressure (MAP) at 10min after the start of the operation in the study group were higher than those in the control group(P<0.05).The CD8+in the study group at 24 h after operation was lower than that in the control group,and CD3+,CD4+,CD4+/CD8+were higher than those in the control group (P<0.05).Neuropeptide Y(NPY),prostaglandin E2(PGE2) and substance P (SP) in the study group at 24 h after operation were lower than those in the control group(P<0.05).The the visual analogue scale (VAS) score in the study group at 24 h after operation was lower than that in the control group,and the Ramsay sedation score was higher than that in the control group (P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion:Ultrasound-guided SP block can enhance the sedative and analgesic effect of patients undergoing modified radical mastectomy for breast cancer,maintain hemodynamic stability,reduce serum pain mediators,reduce immune suppression.