胸肋间筋膜Ⅱ型胸神经阻滞全身麻醉对乳腺癌改良根治术病人血流动力学及应激反应的影响

doi:10.3969/j.issn.1005-6483.20240656

摘要/Abstract

摘要： 目的探讨胸肋间筋膜（PIFB）Ⅱ型胸神经（PECS Ⅱ）阻滞全身麻醉对乳腺癌改良根治术病人血流动力学及应激反应的影响。方法 2021年11月～2023年11月收治并行改良根治术治疗的乳腺癌病人95例，按麻醉方式分为对照组（46例）和观察组（49例）。对照组接受PECS Ⅱ阻滞全身麻醉，观察组接受PIFB-PECS Ⅱ阻滞全身麻醉，比较两组瑞芬太尼用量、顺式阿曲库铵用量、苏醒和气管拔管时间、术后镇痛泵按压次数、视觉模拟量表（VAS）评分、血流动力学[心率（HR）、平均动脉压（MAP）]、氧化应激反应[超氧化物歧化酶（SOD）、过氧化氢酶（CAT）、丙二醛（MDA）]、简易精神状态量表(MMSE)评分和不良反应。结果观察组瑞芬太尼用量、顺式阿曲库铵用量和48小时内镇痛泵有效按压次数少于对照组，苏醒、气管拔管时间和术后首次按压时间短于对照组，术后VAS评分低于对照组，两组比较差异有统计学意义（P<0.05）。观察组麻醉诱导后（T1）、气管插管时（T2）、手术开始时（T3）、手术结束时（T4）时的HR分别为（78.45±6.12）次/分钟、（100.28±11.54）次/分钟、（103.90±14.82）次/分钟、（93.66±9.17）次/分钟，低于对照组的（84.66±7.04）次/分钟、（112.33±13.28）次/分钟、（122.44±17.06）次/分钟、（106.26±11.03）次/分钟,两组比较差异有统计学意义（P<0.05）；观察组T1、T2、T3、T4时的MAP分别为（67.73±4.09）mmHg、（75.22±9.51）mmHg、（90.76±10.77）mmHg、（82.50±8.63）mmHg，对照组分别为（70.10±5.66）mmHg、（82.62±10.17）mmHg、（96.43±12.59）mmHg和（90.82±11.04）mmHg，两组比较差异有统计学意义（P<0.05）。两组术后24小时、72小时SOD、CAT、MDA水平均较术前升高，差异有统计学意义（P<0.05）。观察组术后24小时、72小时的SOD分别为（83.22±15.44）nU/ml和（77.41±10.39）nU/ml，低于对照组的（90.40±18.23）nU/ml和（82.80±13.18）nU/ml；观察组术后24小时、72小时的CAT分别为（16.20±5.03）kU/L、（14.12±3.27）kU/L，低于对照组的（20.75±6.57）kU/L和（17.06±4.35）kU/L；观察组术后24小时、72小时的MDA分别为（5.12±1.33）mmol/L和（3.23±0.76）mmol/L，低于对照组的（6.03±2.24）mmol/L、（4.88±1.05）mmol/L，两组比较差异有统计学意义（P<0.05）。观察组术后24小时、72小时的MMSE评分分别为（28.01±1.35）分和（28.46±1.39）分，高于对照组的（26.44±1.08）分和（27.36±1.23）分，两组比较差异有统计学意义（P<0.05）。结论 PIFB-PECS Ⅱ阻滞全身麻醉应用于乳腺癌改良根治术，可维持血流动力学稳定，降低氧化应激，减轻对认知功能的损害，且安全性较高。

关键词: 乳腺癌改良根治术, 胸肋间筋膜阻滞, Ⅱ型胸神经阻滞, 全身麻醉, 血流动力学, 应激反应

Abstract: Objective To investigate the effect of pectointercostal fascial block（PIFB)PECSⅡ block-general anesthesia on hemodynamics and stress response in patients undergoing modified radical mastectomy for breast cancer.Methods A total of 95 patients with breast cancer who underwent modified radical mastectomy in the hospital from November 2021 to November 2023 were enrolled in this study.They were divided into the control group (n=46) and the observation group (n=49) according to the anesthesia mode.The control group received PECS Ⅱ block general anesthesia and the observation group received PIFB-PECS Ⅱ block-general anesthesia.The dosage of remifentanil,the dosage of cisatracurium,recovery time,tracheal extubation time,postoperative analgesia pump compression times,VAS scores,hemodynamics (HR,MAP),oxidative stress response (SOD,CAT,MDA),and hyperthermia were compared between the two groups Susceptibility to MMSE score and adverse reactions.Results The dosage of remifentanil,dosage of cisatracurium,effective pressing times of analgesia pump within 48 h,wake-up time,tracheal extubation time and time to postoperative first pressing in the observation group were lower and shorter than those in the control group (P<0.05).The observation group had lower VAS scores than the control group after surgery (P<0.05).The HR of after anesthesia induction (T1),at tracheal intubation (T2),at the beginning of surgery (T3) and at the end of surgery (T4) in the observation group was (78.45±6.12) times /min,(100.28±11.54) times /min,(103.90±14.82) times /min and (93.66±9.17) times /min,respectively,which were lower than the control group [(84.66±7.04) times /min,(112.33±13.28) times /min,(122.44±17.06) times /min and (106.26±11.03) times /min,respectively].MAP of T1,T2,T3 and T4 in the observation group were (67.73±4.09) mmHg,(75.22±9.51) mmHg,(90.76±10.77) mmHg and (82.50±8.63) mmHg,respectively,the control groups were (70.10±5.66) mmHg, (82.62±10.17) mmHg, (96.43±12.59) mmHg and (90.82±11.04) mmHg,respectively.There was a statistically significant difference between the two groups (P<0.05). The levels of SOD, CAT and MDA in both groups at 24 hours and 72 hours after the operation were all higher than those before the operation (P<0.05).The SOD levels in the observation group were (83.22±15.44) nU/ml and (77.41±10.39) nU/ml at 24h and 72h after operation.It was lower than that of the control group, which was (90.40±18.23) nU/ml and (82.80±13.18) nU/ml.The CAT scores of observation group were (16.20±5.03) kU/L and (14.12±3.27) kU/L at 24h and 72h after operation,which were lower than those of control group [(20.75±6.57) kU/L and (17.06±4.35) kU/L].The MDA levels in the observation group were (5.12±1.33) mmol/L and (3.23±0.76) mmol/L at 24h and 72h after surgery,which were lower than those in the control group [(6.03±2.24) mmol/L and (4.88±1.05) mmol/L],and the differences were statistically significant (all P<0.05).The MMSE scores of the observation group were (28.01±1.35) and (28.46±1.39),which were higher than those of the control group [(26.44±1.08) and (27.36±1.23)] (P<0.05).Conclusion Applying PIFB-PECS Ⅱ block-general anesthesia in modified radical mastectomy for breast cancer can maintain hemodynamic stability,reduce oxidative stress and alleviate the damage to cognitive function,with high safety.

Key words: modified radical mastectomy for breast cancer, pecto-intercostal fascial block, pectoral nerves Ⅱ block, general anesthesia, hemodynamics, stress response

唐伟张骞刘丽丽. 胸肋间筋膜Ⅱ型胸神经阻滞全身麻醉对乳腺癌改良根治术病人血流动力学及应激反应的影响[J]. 临床外科杂志, 2025, 33(8): 879-883.

TANG Wei, ZHANG Qian, LIU Lili. Effects of pecto-intercostal fascial block-PECS Ⅱ block-general anesthesia on hemodynamics and stress response in patients undergoing modified radical mastectomy for breast cancer[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(8): 879-883.

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