超声引导下胸神经阻滞在乳腺癌改良根治术中的应用效果及对术后各阶段疼痛评分的影响

Effect of ultrasound-guided thoracic nerve block in modified radical resection of breast cancer and its effect on postoperative pain scores in all stages

目的 探究超声引导下胸神经阻滞在乳腺癌改良根治术中的应用效果,并对患者术后各阶段的疼痛评分进行评价分析。方法 前瞻性选取2020年3月至2021年3月在济宁医学院附属医院接受乳腺癌改良根治术治疗的100例患者为研究对象,按照随机数字表法将患者分为对照组和观察组,每组各50例。对照组患者行全身麻醉,观察组患者行全身麻醉联合超声引导下胸神经阻滞。比较两组患者围手术期相关指标(术中出血量、手术时间、苏醒时间、麻醉补救率)及恶心呕吐等情况;采用视觉模拟评分法(VAS)对患者术后2、6、12、24 h的疼痛程度进行评估;于麻醉诱导前(T0)、手术开始后20 min(T1)、手术完成离开手术室(T2)时测定患者的血糖、促肾上腺素皮质激素(ACTH)及多巴胺水平;记录两组患者术后不良反应发生情况。结果 两组的术中出血量及手术时间比较,差异均无统计学意义(P>0.05);观察组患者苏醒时间为(24.46±1.14) min,短于对照组[(35.56±1.16)min],术后恶心呕吐评分、麻醉补救率分别为(1.31±0.56)分、18.00%,均低于对照组[(2.94±0.45)分、42.00%],差异均有统计学意义(P<0.05)。术后2、6、12、24 h,观察组患者的VAS评分分别为(3.73±0.56)、(4.11±1.14)、(4.15±0.96)、(4.31±0.83)分,均低于对照组[(4.33±0.89)、(5.23±1.13)、(5.14±1.07)、(4.94±0.96)分],差异均有统计学意义(P<0.05)。T0时,两组患者的血糖、ACTH及多巴胺水平比较,差异均无统计学意义(P>0.05);T1及T2时,两组应激反应水平均较T0升高,观察组患者的血糖、ACTH及多巴胺水平均低于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为16.00%,低于对照组(42.00%),差异有统计学意义(P<0.05)。结论 对行乳腺癌改良根治术患者进行胸神经阻滞麻醉可以有效减轻患者应激反应,降低患者术后疼痛程度及术后不良反应发生率,具有临床应用潜力。

Objective To explore the effect of ultrasound-guided thoracic nerve tissue in modified radical resection of breast cancer,and to evaluate the postoperative pain scores in various stages.Methods A total of 100 patients who received modified radical surgery for breast cancer in the Affiliated Hospital of Jining Medical University from March 2020 to March 2021 were prospectively selected and divided into the control group and the observation group according to the random number table method,with 50 patients in each group.Patients in the control group underwent general anesthesia,and patients in the observation group underwent general anesthesia combined with ultrasound-guided thoracic nerve block.The perioperative related indicators(intraoperative bleeding volume,surgical time,recovery time,anesthesia recovery rate),as well as nausea and vomiting were compared between the two groups of patients.The pain degree of two groups of patients at 2,6,12,and 24 hours after surgery were evaluated by visual analogue scale(VAS).The levels of blood glucose,adrenocorticotropic hormone(ACTH),and dopamine were measured before anesthesia induction(T 0),20 minutes after surgery(T 1)and after surgery completion and leaving the operating room(T 2)in both groups of patients.The occurrence of postoperative adverse reactions were observed in both groups of patients.Results There was no statistically significant difference between the two groups in operation time and intraoperative bleeding(P>0.05);the awakening time of the observation group was(24.46±1.14)minutes,which was shorter than that of the control group[(35.56±1.16)minutes],the postoperative nausea and vomiting score and anesthesia recovery rate of the observation group were(1.31±0.56)points and 18.00%,respectively,which were lower than those of the control group[(2.94±0.45)points and 42.00%],the differences were statistically significant(P<0.05).The VAS scores of the observation group at 2,6,12 and 24 h were(3.73±0.56),(4.11±1.14),(4.15±0.96),(4.31±0.83)points,respectively,which were lower than those of the control group[(4.33±0.89),(5.23±1.13),(5.14±1.07),(4.94±0.96)points],the differences were statistically significant(P<0.05).At T 0,there was no statistically significant differences in blood glucose,ACTH,and dopamine levels between the two groups of patients(P>0.05);at T 1 and T 2,the stress response levels in both groups were higher than T 0,the blood glucose,ACTH,and dopamine levels in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 16.00%,which was much lower than that in the control group(42.00%),and the difference was statistically significant(P<0.05).Conclusion Thoracic nerve block anesthesia for patients undergoing modified radical mastectomy for breast cancer can effectively reduce stress reaction,pain degree after surgery of pationts,and reduce the occurrence of postoperative adverse reactions,which has clinical application potential.