连续胸椎旁神经阻滞联合全身麻醉对乳腺癌根治手术患者血流动力学、应激反应及生存质量的影响

摘要 目的：探讨连续胸椎旁神经阻滞（TPVB）联合全身麻醉对乳腺癌根治手术患者血流动力学、应激反应及生存质量的影响。方法：选择2017年2月~2019年8月期间于我院行乳腺癌根治手术的乳腺癌患者125例，按照随机数字表法分为A组62例和B组63例，A组给予全身麻醉，B组给予TPVB联合全身麻醉，对比两组血流动力学、应激反应、生存质量、疼痛及不良反应。结果：两组插管前（T1）~拔管时（T4）时间点平均动脉压（MAP）、心率（HR）均较麻醉前（T0）升高，但B组T1~T4时间点MAP、HR低于A组（P<0.05）。B组术后1 d肾上腺素、血糖、去甲肾上腺素及多巴胺水平低于A组（P<0.05）。两组术后6个月躯体角色、躯体功能、情感角色、社会功能、躯体疼痛、总体健康、活力以及心理健康评分均较术前升高（P<0.05）。B组术后4 h、术后12 h、术后24 h安静时视觉模拟评分法（VAS）评分 、运动时VAS评分低于A组（P<0.05）。两组不良反应总发生率对比未见统计学差异（P>0.05）。结论：TPVB联合全身麻醉应用于乳腺癌根治手术患者，可减轻机体应激反应，维持血流动力学平稳，减轻术后疼痛，且不增加不良反应发生率，对生存质量无显著影响。

Effects of Continuous Thoracic Paravertebral Nerve Block Combined with General Anesthesia on Hemodynamics, Stress Response and Quality of Life in Patients with Radical Mastectomy

ABSTRACT Objective: To investigate the effect of continuous thoracic paravertebral nerve block (TPVB) combined with general anesthesia on hemodynamics, stress response and quality of life in patients with radical mastectomy. Methods: 125 patients with breast cancer undergoing radical mastectomy in our hospital from February 2017 to August 2019 were selected, and randomly divided into group A with 62 cases and group B with 63 cases. Group A was given general anesthesia, while group B was given TPVB combined with general anesthesia. Hemodynamics, stress response, quality of life, pain and adverse reactions were compared between the two groups. Results: The mean arterial pressure (MAP) and heart rate (HR) at before intubation (T1) ~ extubation (T4) time points in both groups were higher than those before anesthesia (T0), but MAP and HR at T1-T4 time points in group B were lower than those in group A (P<0.05). The levels of epinephrine, blood glucose, norepinephrine and dopamine in group B were lower than those in group A(P<0.05). The scores of physical role, physical function, emotional role, social function, physical pain, general health, vitality and mental health in the two groups at 6 months after operation were increased than those before operation (P<0.05). The visual analogue scale (VAS) for quietness and VAS for movement in group B at 4 h, 12 h and 24 h after operation were lower than those in group A (P<0.05). There was no significant difference in the total incidence rate of adverse reactions between two groups (P>0.05). Conclusion: TPVB combined with general anesthesia in patients with radical mastectomy can reduce body stress response, maintain stable hemodynamics, reduce postoperative pain, and does not increase the incidence rate of adverse reactions, and its has no significant impact on the quality of life.