超声引导下连续胸椎旁神经阻滞对乳腺癌根治术患者疼痛及应激反应的影响

目的研究超声引导下连续胸椎旁神经阻滞对乳腺癌根治术患者疼痛及应激反应的影响。方法选取2018年7月至2019年6月沧州市中心医院收治的拟行乳腺癌根治术治疗的70例女性患者作为研究对象,并按照随机数表法将其随机分为观察组(35例)和对照组(35例),其中观察组患者采用超声引导下连续胸椎旁神经阻滞予以麻醉及镇痛,对照组患者采用常规全身麻醉及静脉镇痛,对比两组患者疼痛程度以及白介素细胞-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)的变化情况。结果术后,两组患者疼痛评分均逐渐降低(F=836.000、870.000,P均=0.000),且术后6、12、24、48 h观察组患者疼痛评分均明显低于对照组(t=2.254、35.144、8.588、2.597,P=0.027、0.000、0.000、0.012);术后,两组患者IL-6、TNF-α、hs-CRP水平均呈先升高后降低的趋势,且各时间点观察组患者IL-6、TNF-α、hs-CRP水平均明显低于对照组(术后12 h:t=4.292、8.156、4.933,P均=0.000;术后24h:t=5.868、4.500、2.666,P=0.000、0.000、0.010)。结论超声引导下连续胸椎旁神经阻滞能够明显减轻乳腺癌根治术患者的疼痛程度,降低应激反应水平,值得进一步深入研究探讨。

Effect of Continuous Ultrasound-guided Paravertebral Nerve Block on the Pain and Stress Response of Patients Undergoing Radical Mastectomy

Objective To study the effect of continuous ultrasound-guided paravertebral nerve block on the pain and stress response of patients undergoing radical mastectomy.Methods 70 female patients who underwent radical mastectomy in Cangzhou Central Hospital from July 2018 to June 2019 were selected as study subjects and divided,according to random number table,into an observation group(35 cases)and a control group(35 cases).Patients in the observation group were anesthetized and given analgesia with continuous ultrasound-guided paravertebral nerve block,while patients in the control group were given routine general anesthesia and then intravenous analgesia.Pain degree and changes of interleukin-6(IL-6),tumor necrosis factor-a(TNF-a),hypersensitive c-reactive protein(hs-CRP)were compared between the two groups.Results After the surgery,the pain scores of the two groups gradually decreased(F=836.000,870.000,all P=0.000)and the pain scores in the observation group were significantly lower than those in the control group at 6,12,24,and 48 h after the surgery(t=2.254,35.144,8.588,2.597,P=0.027,0.000,0.000,0.012);after the surgery,the levels of IL-6,TNF-α,and hs-CRP in the two groups showed a trend of increase first followed by decrease,and their levels in the observation group were significantly lower than those in the control group at each time point(12 hours after the surgery:t=4.292,8.156,4.933,all P=0.000;24 hours after the surgery:t=5.868,4.500,2.666,P=0.000,0.000,0.010).Conclusion Ultrasound-guided continuous paravertebral nerve block can significantly reduce the pain degree and the stress response level in patients undergoing radical mastectomy,it deserves further research.