陈鹏 周密 张敏

【摘要】 目的：分析在乳腺癌根治术中应用超声引导下胸椎旁神经阻滞复合全身麻醉的效果。方法：采用回顾分析法开展研究，根据不同麻醉方案，将2021年6月—2023年7月于武汉大学中南医院兴山医院行乳腺癌根治术的70例患者分为参照组与研究组，将实施全身麻醉加用超声引导下胸椎旁神经阻滞的35例纳入研究组，仅实施全身麻醉的35例纳入参照组。对比两组围手术期入室时（T0）、麻醉时（T1）、插管时（T2）、切皮时（T3）、腋窝清扫时（T4）、拔管时（T5）、出室时（T6）的麻醉效果、血流动力学变化情况和术后不同时间点的疼痛评分。结果：在T3、T4时，研究组的脑电双频指数均低于参照组，差异均有统计学意义（P<0.05）。在T1、T2、T3、T4、T5、T6时，研究组心率、平均动脉压均低于参照组，差异均有统计学意义（P<0.05）；研究组各时间点的心率、平均动脉压对比，差异无统计学意义（P>0.05）；参照组T0后各时间点的心率、平均动脉压均高于T0时，差异均有统计学意义（P<0.05）。研究组术后2、6、8、12 h的疼痛评分均低于参照组，差异均有统计学意义（P<0.05）。结论：超声引导下胸椎旁神经阻滞复合全身麻醉可增强麻醉效果，且减少患者围手术期血流动力学的波动，还可维持长期术后镇痛效果。

【关键词】 乳腺癌 乳腺癌根治术 超声 胸椎旁神经阻滞复合全身麻醉

The Application of Thoracic Paravertebral Nerve Block Combined with General Anesthesia Guided by Ultrasound in Radical Operation of Breast Cancer and Its Effects on Pain and Hemodynamics/CHEN Peng， ZHOU Mi， ZHANG Min. //Medical Innovation of China， 2024， 21（13）： 0-056

[Abstract] Objective： To analyze the effect of ultrasound guided thoracic paravertebral nerve block combined with general anesthesia in breast cancer radical surgery. Method： Using retrospective analysis method， according to the different anesthesia scheme， 70 patients from June 2021 to July 2023 in Xingshan Hospital， Zhongnan Hospital of Wuhan University were divided into reference group and study group， 35 cases of general anesthesia with ultrasound guided thoracic nerve block into the study group， 35 cases of only general anesthesia were included in the reference group. The anesthetic effect， hemodynamic changes at the time of entering the operation room （T0）， anesthesia （T1）， intubation （T2）， skin incision （T3）， axillary dissection （T4）， extubation （T5） and leaving the room （T6） and pain scores at different time points after operation were compared between the two groups. Result： At T3 and T4， the EEG double-frequency index of the study group were lower than those of the reference group， the differences were significant （P<0.05）. At T1， T2， T3， T4， T5 and T6， the heart rate and mean arterial depression in the study group were lower than those in the reference group， the differences were statistically significant （P<0.05）; there were no statistically significant differences in heart rate and mean arterial pressure at each time point in the study group （P>0.05）. In the reference group， the heart rate and mean arterial pressure at each time point after T0 were higher than that at T0， the differences were statistically significant （P<0.05）. The pain scores of the study group at 2， 6， 8 and 12 h were lower than those of the reference group， the differences were statistically significant （P<0.05）. Conclusion： Ultrasound guided thoracic paravertebral nerve block combined with general anesthesia can enhance the anesthesia effect， reduce the fluctuation of perioperative hemodynamic fluctuations， and maintain long-term postoperative analgesia.

[Key words] Breast cancer Radical mastectomy of breast cancer Ultrasound Thoracic paravertebral nerve block combined with general anesthesia

First-author's address： Department of Anesthesiology， Xingshan Hospital， Zhongnan Hospital of Wuhan University， Yichang 443711， China

doi：10.3969/j.issn.1674-4985.2024.13.012

乳腺癌是全球女性发病率较高的恶性肿瘤之一，每年新发病例数超过200万，死亡病例数超过60万，且发病年龄逐渐年轻化[1-2]。在治疗方法上，乳腺癌治疗技术不断进步，包括内分泌治疗、化疗、放疗、手术、免疫治疗等，对于病理级别和临床分期较低患者，主要采用乳腺癌根治手术彻底切除病灶，预防病灶发生转移，视情况配合放化疗，抑制体内潜在的癌细胞繁殖生长，可延长患者的生存周期。但乳腺癌根治手术改变代谢、神经系统的微环境，会产生一定的应激反应，且术后疼痛明显，影响术后恢复。为了确保手术顺利开展，需加强麻醉管理，减轻手术应激反应[3]。……