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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

37

期数:

2020年6

页码:

531-534

栏目:

临床研究

出版日期:

2020-06-05

文章信息/Info

Title:

Effect of serratus anterior plane block on postoperative analgesia and immune function of patients after modified radical mastectomy

作者:

马　磊¹; 单智铭¹; 胡安民¹; 戴中亮¹; 许　静²

（1.深圳市人民医院麻醉科，广东　深圳　518000；2.深圳市人民医院病理科，广东　深圳　518000）

Author(s):

MA Lei¹; SHAN Zhiming¹; HU Anmin¹; DAI Zhongliang¹; XU Jing²

(1.Department of Anesthesiology， the People′s Hospital of Shenzhen City，Shenzhen 518000，Guangdong Province,China；2.Department of Pathology，the People′s Hospital of Shenzhen City，Shenzhen 518000,Guangdong Province,China)

关键词:

前锯肌平面阻滞; 乳腺癌改良根治术; 术后镇痛; 免疫功能

Keywords:

serratus anterior plane block; modified radical mastectomy; postoperative analgesia; immune function

分类号:

R614.4

DOI:

10.7683/xxyxyxb.2020.06.006

文献标志码:

A

摘要:

目的　观察前锯肌平面阻滞（SAPB）对乳腺癌改良根治术患者术后疼痛及机体免疫功能的影响。方法　选择2018年4月至2019年9月深圳市人民医院行单侧乳腺癌改良根治术的90例女性患者为观察对象，根据术后镇痛方式分为对照组、患者自控静脉镇痛泵（PCIA）组和SAPB组，每组30例。3组患者均采用气管插管全身麻醉，瑞芬太尼、丙泊酚、苯磺顺阿曲库铵维持麻醉深度，术后酌情给予舒芬太尼镇痛；PCIA组患者术毕时给予PCIA，SAPB组在麻醉诱导后行超声引导SAPB。比较3组患者丙泊酚和瑞芬太尼术中用量、拔管时间、术后不同时刻Prince-Henry疼痛评分和Ramsay镇静评分以及手术前后血清自然杀伤（NK）细胞、CD4⁺、CD8⁺T淋巴细胞水平及CD4⁺/ CD8⁺比值，并观察各组患者术后不良反应发生情况。结果　3组患者的手术时间、拔管时间及术中丙泊酚用量比较差异无统计学意义（F=1.462、2.562、1.219，P>0.05）；3组患者术中瑞芬太尼用量比较差异有统计学意义（F=9.432，P<0.05），其中SAPB组患者术中瑞芬太尼用量少于对照组和PCIA组（P<0.05）；PCIA组和对照组患者术中瑞芬太尼用量比较差异无统计学意义 （P>0.05）。SAPB组和PCIA组患者术后12、24 h疼痛评分显著低于对照组（P<0.05）；SAPB组患者术后12、24 h疼痛评分显著低于PCIA组（P<0.05）。术后12、24 h，3组患者的镇静评分比较差异均无统计学意义（P>0.05）。3组患者术前NK细胞、CD4⁺、CD8⁺及CD4⁺/CD8⁺比值比较差异均无统计学意义（P>0.05）；与术前比较，3组患者术后12、24 h的NK细胞、CD4⁺及CD4⁺/CD8⁺比值均显著降低（P<0.05），CD8⁺显著增高（P<0.05）；SAPB组患者术后12、24 h NK细胞、CD4⁺及CD4⁺/CD8⁺比值均高于对照组和PCIA组（P<0.05），CD8⁺低于对照组和PCIA组（P<0.05）。PCIA组和对照组患者术后12、24 h NK细胞、CD4⁺T、CD8⁺及CD4⁺/CD8⁺比值比较差异无统计学意义 （P>0.05）。对照组、PCIA组、SAPB组患者术后不良反应发生率分别为36.7%（11/30）、26.7%（8/30）和6.7%（2/30）；SAPB组患者术后不良反应发生率显著低于对照组（P<0.05）和PCIA组（χ²=7.954、4.320，P<0.05）。结论　SAPB阻滞应用于乳腺癌改良根治术能够减少术中镇痛药物用量，改善术后镇痛效果，降低术后不良反应发生率，且具有一定的免疫保护作用。

Abstract:

Objective　To observe the effect of serratus anterior plane block (SAPB) on postoperative analgesia and immune function of patients who underwent modified radical mastectomy of breast cancer.Methods　Ninety patients who underwent unilateral modified radical mastectomy of breast cancer in the People′s Hospital of Shenzhen from April 2018 to September 2019 were selected as the study objects.The patients were divided into control group,patient-controlled intravenous analgesia (PCIA) group and SAPB group according to analgesia method,with 30 patients in each group.All patients were given general anesthesia through endotracheal intubation,and the remifentanil,propofol and cisatracurium besylate were used to maintain the anesthesia depth;the sufentanil was used dependent on patient′s condition after surgery.The patients in PCIA group was given PCIA at the end of the operation;the patients in the SAPB group received ultrasound guided SAPB after anesthesia induction.The intraoperative dosage of propofol and remifentanil,extubation time,Prince Henry pain score and Ramsay sedation score at different time point after operation,the serum levels of natural killer(NK) cells,CD4⁺　T lymphocytes,CD8⁺　T lymphocytes and CD4⁺　/ CD8⁺　 ratio before and after operation of patients in the three groups were compared.The postoperative adverse reactions of all patients were observed.Results　There was no significant difference in operation time,extubation time and propofol dosage among the three groups (F=1.462,2.562,1,219;P>0.05).There was significant difference in remifentanil dosage among the three groups(F=9.432,P<0.05);the intraoperative dosage of remifentanil of patients in SAPB group was lower than that in the control group and the PCIA group(P<0.05);there was no significant difference in intraoperative dosage of remifentanil dosage between the PCIA group and the control group(P>0.05).The pain scores of patients in SAPB group and PCIA group were lower than those in the control group at 12,24 hours after surgery (P<0.05);the pain score of patients in the SAPB group was lower than that in the PCIA group at 12,24 hours after surgery (P<0.05).There was no significant difference in sedation scores after 12,24 hours after operation among the three groups (P>0.05).There was no significant difference in NK cells cells,CD4⁺　T lymphocytes,CD8⁺　T lymphocytes and CD4⁺　/CD8⁺　 ratio of patients among the three groups before operation(P>0.05).Compared with before operation,the NK cells,CD4⁺　T lymphocytes and CD4⁺　/CD8⁺　 ratio at 12,24 hours after operation decreased significantly and CD8⁺　T lymphocytes increased significantly in the three groups (P<0.05).The NK cells,CD4⁺　T lymphocytes and CD4⁺　/ CD8⁺　 ratio of patients in the SAPB group were significantly higher than those in the control group and the PCIA group and the level of CD8⁺　T lymphocytes was lower than that in the control group and the PCIA group at 12,24 hours after operation (P<0.05).There was no significant difference in NK cells,CD4⁺　T lymphocytes,CD8⁺　T lymphocytes and CD4⁺　/ CD8⁺　 ratio between the PCIA group and the control group at 12,24 hours after operation (P>0.05).The incidence of adverse reactions of patients in control group,PCIA group,SAPB group was 36.7%(11/30),26.7%(8/30) and 6.7%(2/30) respectively.The incidence of adverse reactions of patients in SAPB group was lower than that in the control group and PCIA group (χ²　=7.954，4.320;P<0.05).Conclusion　The application of SAPB in modified radical mastectomy of breast cancer can reduce the intraoperative dosage of anesthetic drugs,improve the postoperative analgesic effect,reduce the incidence of adverse reaction,as well as offer a certain protective effect on immune function.

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更新日期/Last Update: 2020-06-05