PecsⅡ多模式镇痛在乳腺癌切除术中的应用效果及对术后疼痛-应激因子的影响

Application Effect of Pecs Ⅱ-Based Multimodal Analgesia in Mastectomy and Its Impact on Postoperative Pain-stress Factors

目的探究Ⅱ型胸神经阻滞(PecsⅡ)多模式镇痛在乳腺癌切除术中的应用效果及对术后疼痛-应激因子的影响。方法选取2020年4月—2022年3月行乳腺切除手术的成年女性乳腺癌90例,采用随机数字表法分为全身麻醉联合PecsⅡ多模式镇痛组(PGN组)、全身麻醉联合PecsⅡ组(GN组)、单纯全身麻醉组(G组),每组30例。比较3组围术期指标、手术前后疼痛-应激因子[神经肽Y(NPY)、前列腺素E 2(PGE 2)、血管紧张素Ⅰ(AngⅠ)、皮质醇(Cor)]、疼痛程度[视觉模拟评分法(VAS)评分]、镇静程度(Ramsay评分)、生活质量[癌症患者生活质量量表(EORTC QLQ-C30)评分]、功能状态(KPS评分)及不良反应发生率;统计3组乳腺癌术后疼痛综合征(PMPS)发生情况。结果3组手术时间、术中出血量、麻醉时间比较差异无统计学意义(P>0.05);PGN组术后48 h阿片类药物用量少于GN组、G组,住院时间短于GN组、G组(P<0.01)。PGN组术后12、24、48 h血清NPY、PGE 2、AngⅠ、Cor水平低于GN组、G组(P<0.01);PGN组术后2、8、12、24、48 h VAS评分、Ramsay评分低于GN组、G组(P<0.01);PGN组术后3、6个月EORTC QLQ-C30评分、KPS评分高于GN组、G组(P<0.01)。术后48 h,3组不良反应发生率比较差异无统计学意义(P>0.05)。术后6个月,PGN组PMPS发生率低于GN组、G组(P<0.05)。结论PecsⅡ多模式镇痛能提高乳腺癌切除术后镇痛、镇静效果,有效抑制疼痛-应激因子,降低PMPS发生率,有助于改善患者生活质量。

Objective To explore the application effect of pectoral nerve block Ⅱ(PecsⅡ)-based multimodal analgesia in mastectomy and its impact on postoperative pain-stress factors.Methods A total of 90 adult female patients with breast cancer who underwent mastectomy from April 2020 to March 2022 were selected and divided into general anesthesia combined with PecsⅡ-based multimodal analgesia group(PGN group,n=30),general anesthesia combined with PecsⅡ group(GN group,n=30),and general anesthesia alone group(G group,n=30)by random number table method.Perioperative indexes,pain-stress factors[neuropeptide Y(NPY),prostaglandin E 2(PGE 2),angiotensin Ⅰ(AngⅠ),cortisol(Cor))],pain degree[visual analogue scale(VAS)score],sedation degree(Ramsay score),quality of life[European Organization for Research and Treatment(EORTC)Quality of Life Questionnare-Core 30(QLQ-C30)score],functional status[Key Performance Score(KPS)score]and incidence of adverse reactions were compared among the three groups.The incidence of post-mastenctomy pain syndrome(PMPS)was recorded in the three groups.Results There was no significant difference in duration of operation,intraoperative blood loss and duration of anesthesia among the three groups(P>0.05).The amount of opioid in PGN group was lower than that in GN and G group at 48 h after surgery,and the length of hospital stay was shorter than that in GN and G group(P<0.01).The levels of serum NPY,PGE 2,AngⅠ and Cor in PGN group at 12,24 and 48 h after surgery were lower than those in GN group and G group(P<0.01).VAS scores and Ramsay scores in PGN group at 2,8,12,24 and 48 h after surgery were lower than those in GN group and G group(P<0.01).The EORTC QLQ-C30 score and KPS score of PGN group were higher than those of GN group and G group at 3 and 6 months after operation(P<0.01).There was no significant difference in the incidence of adverse reactions among the three groups at 48 h after operation(P>0.05).The incidence of PMPS in PGN group was lower than that in GN group and G group at 6 months after operation(P<0.05).Conclusion PecsⅡ-based multimodal analgesia can improve analgesia and sedation after mastectomy,inhibit pain-stress factors effectively,reduce the incidence of PMPS,and help improve patients'quality of life.