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| 星状神经节阻滞对乳腺癌患者术后乳腺癌相关淋巴水肿的影响 |
| Effect of stellate ganglion block on postoperative breast cancer-related lymphedema in breast cancer patients |
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| DOI：10.12089/jca.2025.02.003 |
| 中文关键词: 星状神经节阻滞 乳腺癌改良根治术 术后恢复质量 乳腺癌相关淋巴水肿 |
| 英文关键词: Stellate ganglion block Modified radical mastectomy Postoperative recovery quality Breast cancer-related lymphedema |
| 基金项目: |
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| 中文摘要: |
目的：观察超声引导下星状神经节阻滞（SGB）对乳腺癌患者乳腺癌相关淋巴水肿及术后恢复质量的影响。
方法：选择2022年10月至2023年10月择期全麻下行乳腺癌改良根治术的女性患者80例，年龄18～64岁，BMI 18.5～25.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为两组：SGB组（S组）和对照组（C组），每组40例。S组术前行超声引导下单次右侧SGB；C组术前仅接受右侧星状神经节超声扫描不进行神经阻滞。记录术后3 d内乳腺癌相关淋巴水肿的发生情况。记录术前1 d和术后1、3 d睡眠时间，术后1、3 d 15项恢复质量评分（QoR-15）及Christensen疲劳评分。记录术后2、8、24 h VAS疼痛评分以及术后24 h内舒芬太尼用量、镇痛泵总按压次数及有效按压次数和补救镇痛例数。记录手术时间、拔管时间、PACU停留时间、术后住院时间、术后腹胀和恶心呕吐的发生情况以及术后神经阻滞相关并发症的发生情况。
结果：与C组比较，S组术后3 d内乳腺癌相关淋巴水肿发生率明显降低，术后1、3 d睡眠时间明显延长，术后1、3 d QoR-15评分明显升高，Christensen疲劳评分明显降低，术后24 h内舒芬太尼用量、镇疼泵总按压次数及有效按压次数明显减少，术后2、8、24 h VAS疼痛评分明显降低，拔管时间、PACU停留时间和术后住院时间明显缩短，术后腹胀和术后恶心呕吐发生率明显降低（P＜0.05）。两组术后24 h内补救镇痛率差异无统计学意义。SGB组无一例发生神经阻滞相关并发症。
结论：在接受乳腺癌改良根治术的女性患者中术前行超声引导下单次SGB，可以降低乳腺癌相关淋巴水肿的发生率，提高术后恢复质量。 |
| 英文摘要: |
Objective: To observe the effect of preoperative ultrasound-guided stellate ganglion block on the breast cancer-related lymphedema and quality of postoperative recovery in breast cancer patients.
Methods: Eighty female patients underwent modified radical mastectomy under elective general anesthesia were selected from October 2022 to October 2023, aged 18-64 years, BMI 18.5-25.0 kg/m2, ASA physical status Ⅰ or Ⅱ. The patients were randomly assigned to two groups using random number table method: stellate ganglion block group (group S) and control group (group C), 40 patients in each group. Group S underwent a single right-sided ultrasound-guided stellate ganglion block before surgery. Group C only received ultrasound scanning of the right stellate ganglion before surgery without undergoing nerve block. The incidence of breast cancer-related lymphedema within 3 days after surgery was recorded. Sleep duration 1 day before surgery, 1 day and 3 days after surgery, along with the 15-item recovery quality scores (QoR-15) and Christensen fatigue scale 1 day and 3 days after surgery were recorded. VAS pain scores at 2, 8, and 24 hours postoperatively, as well as sufentanil consumption, the total and effective presses number of analgesic pump, and rescue analgesia within 24 hours postoperative were also documented. Surgical time, extubation time, PACU stay time, postoperative hospital stay, and the occurrence of postoperative nerve block-related complications were recorded.
Results: Compared with group C, the incidence of breast cancer-related lymphedema within 3 days after surgery in group S was significantly reduced, with significantly longer sleep duration, significantly higher QoR-15 scores, significantly decreased Christensen fatigue scores 1 day and 3 days after surgery, significantly reduced sufentanil usage within 24 hours postoperatively, total number of analgesic pump presses, and effective press counts, significantly lower VAS pain scores at 2, 8, and 24 hours postoperatively, significantly shorter extubation time, PACU stay time, postoperative hospital stay, and significantly lower incidence of postoperative abdominal distension, nausea and vomiting (P < 0.05). There was no statistically significant difference in the rescue analgesia rate within 24 hours postoperatively between the two groups. No nerve block-related complications occurred in group S.
Conclusion: The single preoperative use of SGB in patients undergoing modified radical mastectomy can reduce the occurrence of breast cancer-related lymphedema and improve the quality of postoperative recovery. |
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