%0 Journal Article
%T 超声引导下竖脊肌平面阻滞对乳腺癌根治术患者围术期的影响
%A 张子英
%A 　王玉娟　翟艳艳　赵涛　梁永新
%J -
%D 2019
%R 10.13362/j.jpmed.201906007
%X 摘要 目的　探讨超声引导下竖脊肌平面阻滞对乳腺癌根治术患者围术期的影响。 方法　选取2019年1月—3月本院择期初次行单侧乳腺癌根治术的女性患者60例。分为全身麻醉组（对照组）和竖脊肌平面阻滞联合全身麻醉组（联合组）。术后均采用静脉患者自控镇痛。术后第6、12、24、48小时时进行静息和咳嗽时视觉模拟量表(VAS)评分；记录患者自控静脉镇痛泵（PCIA）有效按压次数；麻醉前10 min与术后第24、48小时时检测外周血清中炎性递质C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）水平及疼痛递质神经肽Y（NPY）、前列腺素E2（PGE2）、5-羟色胺（5-HT）的含量；记录患者相关不良反应及镇痛满意度。 结果　联合组术中瑞芬太尼用量显著低于对照组（t=－4.713，P＜0.05）。术后第6、12、24小时时联合组静息及咳嗽状态下VAS评分均低于对照组（F=6.088～23.209，P＜0.05）。联合组术后第24小时时血清中CRP、IL-6、TNF-α、NPY、PGE2、5-HT水平均低于对照组（F=17.639～483.602，P＜0.05）。联合组术后24、48 h内PCIA有效按压次数低于对照组（F=12.058、24.470，P＜0.05）。术后48 h内镇痛满意度高于对照组（χ2=10.417，P＜0.05）。 结论　超声引导下竖脊肌平面阻滞可安全有效地应用于乳腺癌根治手术，显著降低乳腺癌根治术后患者VAS评分和炎性反应，提高患者满意度。<br>Abstract：Objective　To investigate the effect of ultrasound-guided erector spinae plane block in the perioperative period of radical mastectomy. Methods　Sixty female patients who underwent initial elective unilateral radical mastectomy in our hospital from January to March 2019 were selected and randomly divided into general anesthesia group (control group) and erector spinae plane block combined with general anesthesia group (combination group). Patient-controlled intravenous analgesia (PCIA) was performed postoperatively. Visual Analogue Scale (VAS) scores at rest and cough were recorded at 6, 12, 24, and 48 h after surgery. The number of effective PCIA pump pressings was recorded. The serum levels of inflammatory mediators, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), as well as pain neurotransmitters, neuropeptide Y (NPY), prostaglandin E2 (PGE2), and 5-hydroxytryptamine (5-HT), were measured 10 min before anesthesia and at 24 and 48 h after surgery. Related adverse reactions and analgesia satisfaction were recorded. Results　Compared with the control group, the combination group had a significantly lower dose of remifentanil (t=-4.713,P<0.05). The VAS scores at rest and cough were significantly lower in the combination group than in the control group at 6, 12, and 24 h after surgery (F=6.088-23.209,P<0.05). The combination group had significantly lower serum levels of CRP, IL-6, TNF-α, NPY, PGE2, and 5-HT than the control group at 24 h after surgery (F=17.639-483.602,P<0.05). The number of effective PCIA pump pressings was significantly lower in the combination group than in the control group at 24 and 48 h after surgery (F=12.058,24.470,P<0.05). The combination group had a significantly higher degree of satisfaction with analgesia than the control group (χ2=10.417,P<0.05). Conclusion　Ultrasound-guided erector spinae plane block can be safely and effectively used in
%K 椎旁肌
%K 神经传导阻滞
%K 乳房切除术
%K 根治性
%K 乳腺肿瘤
%K 术后镇痛
%K 炎症<br>Paraspinal muscles
%K Nerve block
%K Mastectomy
%K radical
%K Breast neoplasms
%K Postoperative analgesia
%K Inflammation
%U http://jpmed.qdu.edu.cn/CN/10.13362/j.jpmed.201906007