目的:分析超声引导下胸神经阻滞在乳腺良性肿瘤手术中的应用。
方法:对69例乳腺良性肿瘤切除术患者(纤维瘤,段)于2021年1月至2022年6月在秦皇岛妇幼保健中心。其中,33例接受TNB的患者被分配到观察组,36例接受局部浸润麻醉的患者被分配到对照组.记录患者麻醉前(T0)的心率(HR)、收缩压(SBP)和舒张压(DBP),在皮肤切口(T1),在手术后0.5小时(T2)和离开手术室前(T3)。我们还记录了运行指标,包括操作时间,术中给予异丙酚的总剂量,麻醉恢复时间和拔管时间。术后0.5、2、4、6h进行视觉模拟评分(VAS)。比较两组免疫球蛋白(Ig)A水平,IgG,白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。对两组患者术后不良反应进行统计学分析。
结果:与观察组相比,对照组手术时间较长,麻醉苏醒时间和拔管时间以及消耗更多的丙泊酚(P<0.001)。在T0和T1时,两组的SBP没有显着差异,DBP和HR(P>0.05),但在T2和T3时,对照组表现出更高的SBP,观察组DBP和HR优于对照组(P<0.001)。对照组VAS评分明显高于观察组(P<0.001)。操作前,IgA水平的差异,IgG,IL-6和TNF-α在两组间差异无统计学意义(P>0.05)。在手术后和手术后24小时,对照组的IgA水平较高,IgG,IL-6和TNF-α与观察组比较(P<0.01)。两组不良反应发生率差异无统计学意义(P>0.05)。
结论:超声引导下的TNB可显著减少乳腺良性肿瘤患者的手术时间和术后疼痛。不增加不良反应的发生率。
OBJECTIVE: To analyze the application of ultrasound-guided thoracic nerve block (TNB) in the operation of benign breast tumors.
METHODS: A retrospective analysis was conducted on 69 patients who underwent resection of benign breast tumors (fibroma, segment) in the Maternity and Child Care Center of Qinhuangdao from January 2021 to June 2022. Among them, 33 patients who received TNB were assigned to an observation group, and 36 patients who received local infiltration anesthesia were assigned to a control group. The heart rate (HR) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) of patients were recorded before anesthesia (T0), at skin incision (T1), at 0.5 h after operation (T2) and before leaving the operating room (T3). We also recorded the operation indexes, comprising operation time, total propofol dosage administered during operation, anesthesia recovery time and extubation time. The visual analogue scale (VAS) score was evaluated at 0.5, 2, 4 and 6 h after the operation. The two groups were also compared in terms of the levels of immunoglobulin (Ig) A, IgG, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). The postoperative adverse reactions in the two groups were statistically analyzed.
RESULTS: Compared with the observation group, the control group experienced a longer operation time, anesthesia recovery time and extubation time and consumed more propofol (P < 0.001). At T0 and T1, the two groups were not notably different in SBP, DBP and HR (P > 0.05), but at T2 and T3, the control group showed higher SBP, DBP and HR than the observation group (P < 0.001). The control group exhibited notably higher VAS scores than the observation group (P < 0.001). Before operation, the differences in the levels of IgA, IgG, IL-6 and TNF-α were not significantly different between the two groups (P > 0.05), while after operation and at 24 h after operation, the control group showed higher levels of IgA, IgG, IL-6 and TNF-α in comparison to the observation group (P < 0.01). The incidences of adverse reactions were not significantly different between the two groups (P > 0.05).
CONCLUSIONS: Ultrasound-guided TNB can substantially reduce both the operation time and the postoperative pain in patients with benign breast tumors, without increasing the incidence of adverse reactions.