超声引导下前锯肌平面阻滞联合音乐疗法对日间乳腺手术患者镇痛效果及焦虑情绪的影响

Influence of ultrasound-guided serratus anterior plane block combined with music therapy on analgesic effect and anxiety of patients undergoing daytime breast surgery

目的观察超声引导下前锯肌平面阻滞(SAPB)联合音乐疗法对日间乳腺手术患者镇痛效果和焦虑情绪的影响。方法选取2020年3月至2021年3月拟于该院行日间乳腺肿块切除术患者90例,采取随机数字表法分为局部浸润麻醉组(A组)、超声引导下SAPB组(B组)、超声引导下SAPB+音乐疗法组(C组),各30例。A组由手术医生行瘤体周围局部浸润麻醉,B组、C组行手术侧超声引导下SAPB,C组手术期间同时联合音乐疗法。记录3组患者切皮时(T_(1))、肿块切除术时(T_(2))、缝皮时(T_(3))、术后30 min(T_(4))、术后60 min(T_(5))、术后120 min(T_(6))疼痛视觉模拟量表(VAS)评分;记录3组患者术前30 min及术毕时状态焦虑问卷(S-AI)评分,术中补救镇痛次数和局部麻醉药使用总量,手术医生和患者满意度及不良反应发生情况。结果3组患者的VAS评分差异有统计学意义(P<0.05);3组患者术前30 min S-AI评分无明显差异(P>0.05),术毕时A组S-AI评分明显高于其他两组,且C组S-AI评分明显低于B组(P<0.01);B组、C组补救镇痛次数明显少于A组(P<0.01),但局部麻醉药使用总量明显高于A组(P<0.01);B组、C组手术医生及患者满意度评分明显高于A组(P<0.01);3组患者均未发生不良反应。结论超声引导下SAPB联合音乐疗法镇痛及缓解焦虑效果确切,安全可靠,可用于日间乳腺包块切除术。

Objective To observe the influence of ultrasound-guided serratus anterior plane block(SAPB)combined with music therapy on analgesia effect and anxiety in patients undergoing daytime breast surgery.Methods A total of 90 patients proposed to undergo daytime breast surgery from March 2020 to March 2021 in this hospital were selected and divided into the local anesthesia group(group A),the ultrasound-guided SAPB group(group B),and the ultrasound-guided SAPB+music therapy group(group C)by random number table method,with 30 cases in each group.Patients in group A underwent local anesthesia around the tumor,and those in group B and group C underwent ultrasound-guided SAPB on the surgical side,while group C combined with music therapy during surgery.The visual analogue scale(VAS)scores of the three groups were recorded at the time of cutaneous resection(T_(1)),mass resection(T_(2)),suture(T_(3)),and 30(T_(4)),60(T_(5)),and 120(T_(6))minutes after surgery.The scores of state anxiety inventory(S-AI)at 30 minutes before surgery and at the end of surgery,the number of remedial analgesia,the total amount of local anesthetics used,the satisfactions of surgeon and patient,and the occurrence of adverse reactions were recorded in the three groups.Results There were significant differences in VAS scores among the three groups(P<0.05).There was no significant difference in the S-AI scores of the three groups at the 30 minutes before surgery(P>0.05).At the end of the surgery,the S-AI score of group A was significantly higher than that of the other two groups,and the S-AI score of group C was significantly lower than that of group B(P<0.01).The number of remedial analgesia in group B and group C was significantly less than that in group A(P<0.01),but the total amount of local anesthetics used was significantly higher than that in group A(P<0.01).The satisfaction of surgeons and patients in group B and group C was significantly better than that in group A(P<0.01).No adverse reactions occurred in any of the three groups.Conclusion Ultrasound-guided SAPB combined with music therapy has definite analgesic and anxiety relieving effects,is safe and reliable,and can be used for daytime breast mass resection.