超声引导下胸部神经阻滞在乳腺癌根治术麻醉中的应用

Application of Ultrasound-guided Thoracic Nerve Block in Anesthesia for Radical Mastectomy

目的:评估超声引导下胸部神经阻滞技术在乳腺癌根治术中的麻醉效果及其对术后疼痛控制的影响。方法:选取滨州医学院附属医院在2022年9月—2023年6月行乳腺癌根治术的100例患者为本研究对象,利用随机数字表法将患者分为对照组(n=50)和观察组(n=50)。对照组接受常规全身麻醉,观察组在对照组基础上接受超声引导下胸部神经阻滞。比较两组麻醉及苏醒期质量(气管导管拔管时间、自主呼吸恢复时间、苏醒时间、恢复室滞留时间)、术后6、12、24、48 h的镇痛效果[视觉模拟评分法(VAS),有效镇痛时间]、不同时间点的氧化应激水平[麻醉诱导前、手术结束时、术后24 h、术后48 h的血清丙二醛(MDA)、超氧化物歧化酶(SOD)]及不良反应发生情况(恶心、呕吐、术后寒战、心率减慢、头晕)。结果:观察组气管导管拔管时间、自主呼吸恢复时间、苏醒时间均早于对照组,恢复室滞留所需时间短于对照组,差异均有统计学意义(P<0.05)。观察组术后6、12、24、48 h的VAS评分均远低于对照组,有效镇痛时间长于对照组,差异均有统计学意义(P<0.05)。手术结束时、术后24、48 h,两组血清MDA水平均高于麻醉诱导前(P<0.05);术后24、48 h,观察组的血清MDA水平均较对照组低,SOD水平均高于对照组,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在全身麻醉基础上超声引导下胸部神经阻滞可以显著改善乳腺癌根治术患者的麻醉质量和术后镇痛效果,缩短恢复时间,降低氧化应激水平,且未增加不良反应的发生率。

Objective:To evaluate the anesthetic efficacy of ultrasound-guided thoracic nerve block in radical mastectomy and its influence on postoperative pain control.Method:A total of one hundred patients undergoing radical mastectomy at Binzhou Medical University Hospital from September 2022 to June 2023 were selected as the subjects of this study,patients were divided into a control group(n=50)and an observation group(n=50)by random number table method.The control group received conventional general anesthesia,observation group received ultrasound-guided thoracic nerve block on the basis of the control group.Anesthesia and awakening period quality(time for tracheal tube removal,autonomous breathing recovery time,awakening time,and recovery room retention time),postoperative analgesic effects at 6,12,24,and 48 hours[visual analogue scale(VAS),effective pain relief duration],oxidative stress levels at different time points[preanesthetic,end of surgery,24 hours postoperatively,48 hours postoperatively serum malondialdehyde(MDA),superoxide dismutase(SOD)]and incidence of adverse reactions(nausea,vomiting,postoperative chills,bradycardia,dizziness)were compared between two groups.Result:Times for tracheal tube removal,autonomous breathing recovery,awakening in the observation group were earlier than those in the control group,and recovery room stay in the observation group was significantly shorter than that in the control group,the differences were statistically significant(P<0.05).The VAS scores at 6,12,24,and 48 hours postoperatively in the observation group were significantly lower than those in the control group,duration of effective pain relief was longer than that in the control group,the differences were statistically significant(P<0.05).At the end of surgery,and at 24 and 48 hours postoperatively,the serum MDA levels in both groups were higher than before anesthesia induction(P<0.05);at 24 and 48 hours postoperatively,the serum MDA levels in the observation group were lower than those in the control group,while the SOD levels were higher than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).Conclusion:Ultrasound-guided thoracic nerve block on the basis of general anesthesia significantly improves anesthesia quality and postoperative pain relief in patients undergoing radical mastectomy,reduces recovery time,decreases oxidative stress levels,and does not increase the incidence of adverse reactions.