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| 超声引导下前锯肌平面阻滞对乳腺癌患者术后镇痛的影响 |
| Effect of ultrasound-guided anterior serratus plane block on postoperative analgesia in patients with breast cancer |
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| DOI：10.12089/jca.2019.12.007 |
| 中文关键词: 超声引导 前锯肌平面阻滞 乳腺癌改良根治术 急性疼痛 细胞免疫 |
| 英文关键词: Ultrasound-guided Serratus plane block Modified radical mastectomy Acute pain Cellular immunity |
| 基金项目:广东省医学科学技术研究基金（B2018001） |
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| 中文摘要: |
目的 探讨超声引导下前锯肌平面（serratus plane, SP）阻滞对乳腺癌患者术后急性疼痛和细胞免疫功能的影响。
方法 选择2016年1月至2018年6月在本院行择期乳腺癌改良根治术女性患者60例，年龄40～65岁，BMI 20.1～24.5 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法随机分为两组：SP阻滞联合全身麻醉组（S组）和全身麻醉组（N组），每组30例。两组均采用气管插管静脉全身麻醉，S组在麻醉诱导后在超声引导下行患侧SP阻滞，注射0.3 %罗哌卡因25 ml。N组不行SP阻滞。术后两组均行舒芬太尼PCIA。记录术后舒芬太尼用量、术后首次按压镇痛泵时间和48 h内镇痛泵有效按压次数。记录麻醉诱导前、术毕、术后24和48 h NK细胞、NKT细胞、调节性T细胞百分比。记录术后48 h内不良反应的发生情况。
结果 与N组比较，S组术后舒芬太尼用量明显减少（P<0.05），术后首次按压时间明显延长（P<0.05），术后48 h内镇痛泵有效按压次数明显减少（P<0.05）。与麻醉诱导前比较，术毕、术后24、48 h N组NK细胞、NKT细胞百分比明显降低，调节性T细胞百分比明显升高（P<0.05）。与N组比较，术毕、术后24、48 h S组NK细胞、NKT细胞百分比明显升高，调节性T细胞百分比明显降低（P<0.05）。两组术后48 h内均无一例不良反应。
结论 乳腺癌手术患者实施超声引导下前锯肌平面阻滞能明显缓解术后急性疼痛，减少围术期镇静镇痛药使用并减轻免疫抑制程度。 |
| 英文摘要: |
Ojective To investigate the effect of ultrasound-guided serratus plane (SP) block on acute pain and cellular immunity function in patients undergoing modified radical mastectomy.
Methods Sixty patients undergoing modified radical mastectomy for breast cancer from January 2016 to June 2018 were selected, aged 40-65 years, BMI 20.1-24.5 kg/m2 , ASA physical status Ⅰ or Ⅱ. Patients were randomly divided into 2 groups: SP block combined with general anesthesia group (group S) and the general anesthesia group (group N), 30 cases in each group. Group S received ultrasound-guided SP block after anesthesia induction, and 0.3% ropivacaine 25 ml was injected. All patients received PCIA postoperatively. The first pressing time of the analgesic pump, the number of press analgesic pump, and the consumption of sufentanil were recorded within 48 h after operation. The percentages of NK cells, NKT cells and regulatory T cells were recorded before induction, at the end of operation, postoperative 24 h and 48 h. Block related complications and analgesic related adverse reactions were recorded.
Results Compared with group N, the dosage of sufentanil in group S were decreased significantly (P < 0.05), the first pressing analgesia time, postoperative analgesia pump in 48 h press times in group S were lower (P < 0.05). Compared with group N, the percentages of NKT cells and NK cells at the end of operation, 24 and 48 h after operation in group S were significantly higher (P < 0.05), and the percentages of regulatory T cells were lower (P < 0.05). The two groups showed no adverse reaction 48 h after operation.
Conclusion The implementation of ultrasound guided serratus plane block for modified radical mastectomy of breast cancer can significantly relieve acute pain after surgery, and alleviate the degree of immune suppression. |
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