超声引导下胸横肌平面-胸神经阻滞和胸椎旁神经阻滞用于乳腺癌改良根治术的效果比较

目的:比较超声引导下胸横肌平面-胸神经阻滞（TTP-PECS）和胸椎旁神经阻滞（TPVB）用于乳腺癌改良根治术的效果。方法:将80例择期行单侧乳腺癌改良根治术的女性患者，ASA Ⅰ-Ⅱ级，年龄28~74岁，身高151~172 cm，体重47~72 kg，采用随机数字表法分为2组（n=40）:TTP-PECS组（TP组）和TPVB组（T组）。TP组行超声引导下患侧TTP-PECS，T组行超声引导下患侧TPVB。比较两组患者术中、PACU和术后24 h PCIA芬太尼消耗量，PCIA有效按压次数，补救镇痛率，阻滞镇痛维持时间；比较两组患者不同时间点血清IL-6、MCP-1和TNF-α水平，及NPY、PGE2和β-内啡肽水平；比较两组患者术后恢复各相关指标。结果:与T组比，TP组患者术后24 h PCIA芬太尼消耗量，PCIA有效按压次数和补救镇痛率明显降低，阻滞镇痛时间明显延长；术后12 h的IL-6、MCP-1和TNF-α水平及PGE2、NPY和β-内啡肽水平均明显降低；术后低血压和心动过缓发生率，12 h DSIS睡眠干扰评分和首次下床活动时间明显降低（P＜0.05）。结论:超声引导下胸横肌平面-胸神经阻滞用于乳腺癌改良根治术，较胸椎旁神经阻滞的术后镇痛效果更持久，更有利于抑制术后炎性反应，促进患者术后早期转归。

Comparison of effect between ultrasound-guided transversus thoracic muscle plane-pectoral nerves block and thoracic paravertebral nerve block in patients underdoing modified radical mastectomy

Objective:To compare the effect between ultrasound-guided transversus thoracic muscle plane-pectoral nerves block(TTP-PECS) and thoracic paravertebral nerve block(TPVB) in patients underdoing modified radical mastectomy.Methods:80 patients of female,age 28~74 years old,height 151~172 cm,weighing 47~72 kg,ASA Ⅰ-Ⅱ,scheduled for elective modified radical mastectomy,were randomly divided into two groups(n=40):TTP-PECS group(group TP) and TPVB group(group T).Ultrasound-guided TTP-PECS was performed in group TP and TPVB in group T.Intraoperative,PACU and postoperative 24 h PCIA fentanyl consumption,effective PCIA pressing,rate of postoperative remedial analgesia,as well as analgesia duration were compared.The levels of IL-6,MCP-1 and TNF-α,as well as PGE2,NPY and beta-endorphins were checked at different times. The relative in-dexes of postoperative outcomes were also compared.Results:Compared with group T,the postoperative 24 h PCIAfentanyl consumption,effective PCIA pressing,and rate of postoperative remedial analgesia were decreased,and theanalgesia duration was increased. The levels of IL-6,MCP-1 and TNF-α,as well as PGE2,NPY and beta-endor-phins were reduced at postoperation 12 h. The incidence of hypotension and bradycardia,the scores of 12 h daily sleepinterference scale,and the time of first ambulation were significantly reduced in group TP(P< 0. 05).Conclusion:Compared with TPVB,ultrasound-guided TTP-PECS can provide better postoperative analgesia,better inhibit post-operative inflammatory reaction and promote early outcomes in patients underdoing modified radical mastectomy.