三种不同神经阻滞方法对乳腺良性肿瘤切除手术患者术后疼痛及应激反应的影响比较

Comparison of the effects of three different nerve block methods on postoperative pain and stress response in patients undergoing benign breast tumor resection surgery

目的 探究Ⅰ型胸神经胸壁神经阻滞(PECSⅠ)、Ⅱ型胸神经PECS(PECSⅡ)、前锯肌平面阻滞对乳腺良性肿瘤切除手术患者术后疼痛及应激反应的影响。方法 选取研究对象为2021年11月至2023年11月在秦皇岛市妇幼保健院接受乳腺良性肿瘤切除手术的患者,共120例,患者均进行全身麻醉,采用信封法对患者进行分组:观察1组(n=42)接受PECSⅠ,观察2组(n=41)接受前锯肌平面阻滞;观察3组(n=37)接受PECSⅡ,术后均采用舒芬太尼行静脉自控镇痛,比较各组患者的舒芬太尼使用量、拔管时间、苏醒时间,比较各组患者皮肤痛觉阻滞总节段范围,并对患者术后不同时间的VAS评分、应激指标水平进行比较,记录并比较各组的不良反应情况。结果 观察2组患者的舒芬太尼使用量高于观察1组、观察3组,差异有统计学意义(P<0.05),但观察1组、观察3组组间差异无统计学意义(P>0.05);观察2组、观察3组患者的拔管时间长于观察1组,差异有统计学意义(P<0.05),但观察2组、观察3组组间差异无统计学意义(P>0.05);观察2组苏醒时间长于观察1组,差异有统计学意义(P<0.05),但观察1组、观察3组间,观察2组、观察3组组间苏醒时间比较,差异均无统计学意义(P>0.05)。观察2组在锁骨中线、腋前线的皮肤痛觉阻滞总节段均大于观察1组、观察3组,差异有统计学意义(P<0.05),但观察1组、观察3组组间差异无统计学意义(P>0.05);观察1组、观察2组、观察3组在腋中线及腋后线的皮肤痛觉阻滞总节段组间比较差异无统计学意义(P>0.05)。出复苏室时,3组间VAS评分差异无统计学意义(P>0.05),在术后4、12、24 h时,观察2组、观察3组的VAS评分低于观察1组,差异有统计学意义(P<0.05),但观察2组、观察3组组间差异无统计学意义(P>0.05)。3组患者的术前及术后2 h的去甲肾上腺素、肾上腺素及血管紧张素Ⅱ水平比较,组间差异均无统计学意义(P>0.05)。3组患者的不良反应比较,组间差异无统计学意义(P>0.05)。结论 在乳腺良性肿瘤切除手术中,前锯肌平面阻滞在术后恢复、阻滞节段方面显示出优势,其镇痛效果、麻醉效果与胸椎旁神经阻滞相当。PECSⅠ、前锯肌平面阻滞、PECSⅡ均能够改善患者的术后疼痛情况,麻醉效果较好,可根据临床实际灵活选择。

Objective To explore the effects of typeⅠthoracic nerve pectoral nerves block(PECSⅠ),typeⅡthoracic nerve(PECSⅡ)and serratus anterior plane block on postoperative pain and stress response in patients undergoing benign breast tumor resection.Methods The study subjects were patients who underwent benign breast tumor resection in Qinhuangdao Maternal and Child Health Hospital from November 2021 to November 2023,A total of 120 cases,underwent general anesthesia.Patients were grouped according to different nerve block methods:the observation group 1(n=42)received PECSⅠ,and the observation group 2(n=41)received serratus anterior plane block,the observation group 3 received PECSⅡ(n=37).Postoperatively,sufentanil was used for intravenous-controlled analgesia,the amount of sufentanil use,extubation time,awakening time in each group were compared,the total segment range of skin pain block in each group were compared,and the VAS scores of the patients at different times after surgery,the levels of stress indicators at different times were compared,adverse reactions were recorded in each group.Results The amount of sufentanil used in the observation group 2 was higher than that in the observation group 1 and the observation group 3,and the difference was statistically significant(P<0.05),but there was no significant difference between the observation group 1 and the observation group 3(P>0.05).The extubation time of the observation group 2 and the observation group 3 was longer than that of the observation group 1,and the difference was statistically significant(P<0.05);but there was no significant difference in the recovery time between the observation group 1 and the observation group 3,and between the observation group 2 and the observation group 3(P>0.05).The total segment of skin pain block in the midclavicular line and the anterior axillary line of the observation group 2 was greater than that of the observation group 1 and the observation group 3,and the difference was statistically significant(P<0.05),but there was no significant difference between the observation group 1 and the observation group 3(P>0.05);There was no significant difference in the total segment of skin pain block in the midaxillary line and the posterior axillary line between the observation group 1,the observation group 2 and the observation group 3(P>0.05).There was no significant difference in VAS score among the three groups at the time of leaving the resuscitation room(P>0.05).At 4,12 and 24 h after operation,the VAS scores of the observation group 2 and the observation group 3 were lower than those of the observation group 1,and the differences were statistically significant(P<0.05),but there was no significant difference between the observation group 2 and the observation group 3(P>0.05).There were no differences in norepinephrine,adrenaline and angiotensin before or 2 h between the three groups(P>0.05).There was no significant difference in the levels of norepinephrine,epinephrine and angiotensinⅡbetween the three groups before and 2 h after operation(P>0.05).There was no significant difference in adverse reactions among the three groups(P>0.05).Conclusion In the benign breast tumor resection operation,serratus anterior plane block shows advantages in postoperative recovery and block segments,and its analgesic effect and anesthetic effect are comparable to those of thoracic paravertebral nerve block.PECSⅠ,serratus anterior plane block and PECSⅡcan improve the postoperative pain of patients,and the anesthesia effect is good,which can be selected flexibly selected according to the clinical practice.