摘要
目的:探讨全身麻醉联合超声引导前锯肌平面阻滞对机器人辅助乳腺癌根治术患者术后康复的影响。方法:选取2023年1月—2025年1月于咸阳市第一人民医院行机器人辅助乳腺癌根治术的102例患者作为研究对象,采用随机数字表法将其分为对照组(采用传统全身麻醉)和观察组(采用全身麻醉联合超声引导前锯肌平面阻滞),每组各51例。比较两组患者的术后疼痛、认知功能、脑氧代谢指标、应激与炎症反应指标、并发症及术中麻醉药物用量。结果:与术前相比,两组患者术后24 h、48 h和7 d的数字评分法(NRS)评分呈下降趋势(P<0.05);与对照组相比,观察组术后各时间点的NRS评分均更低(P<0.05)。与术前相比,两组患者术后24 h、48 h的简易精神状态检查量表(MMSE)评分均有所降低(P<0.05);与术前相比,术后7 d时上述评分升高,但差异无统计学意义(P>0.05);观察组术后24 h MMSE评分显著高于对照组(P<0.05);术后48 h、7 d观察组评分略高于对照组,但差异无统计学意义(P>0.05)。与T0相比,两组在T1时脑氧饱和度(rSO_(2))、颈内静脉血氧饱和度(SjvO_(2))水平均显著降低,乳酸(Lac)水平显著升高;T2时,两组rSO_(2)、SjvO_(2)水平较T1显著回升(仍低于T0),Lac水平较T1显著下降(仍高于T0),差异有统计学意义(P<0.05);与对照组相比,观察组在T1和T2时的rSO_(2)、SjvO_(2)水平均更高,Lac水平均更低(P<0.05)。与T0时相比,两组患者T1和T2时间点的皮质醇(Cor)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均升高(P<0.05);与对照组相比,观察组在T1和T2时间点的Cor、IL-6、TNF-α水平均较低(P<0.05)。比较两组患者并发症总发生率,差异无统计学意义(P>0.05)。与对照组相比,观察组术中七氟醚平均吸入浓度更低,瑞芬太尼总用量更少(P<0.05);而两组患者顺式阿曲库铵总用量的差异无统计学意义(P>0.05)。结论:全身麻醉联合超声引导下前锯肌平面阻滞技术可有效缓解机器人辅助乳腺癌根治术患者的术后疼痛,改善术中脑氧代谢并维持其平衡,对患者术后早期认知功能可能具有保护作用,且未增加相关并发症风险,具有良好的临床应用价值。
Objective:To investigate the effect of general anesthesia combined with ultrasound-guided serratus anterior plane block on postoperative recovery in patients undergoing robot-assisted radical mastectomy.Methods:102 breast cancer patients who underwent robot-assisted radical mastectomy at Xianyang First People’s Hospital from January 2023 to January 2025 were selected.They were randomly divided into the control group(n=51,receiving conventional general anesthesia)and the observation group(n=51,receiving general anesthesia combined with ultrasound-guided serratus anterior plane block).Postoperative pain level,cognitive function,cerebral oxygen metabolism indicators,stress and inflammatory response indicators,complications,and intraoperative anesthetic drug usage were compared between the two groups.Results:Compared with those before surgery,the numerical rating scale(NRS)scores at 24 h,48 h,and 7 d postoperatively showed a decreasing trend in the two groups(P<0.05).The observation group had significantly lower NRS scores at all timepoints compared to the control group(P<0.05).Compared with preoperative values,the mini-mental state examination(MMSE)scores at 24 h and 48 h postoperatively decreased in the two groups(P<0.05).Compared with that before surgery,the MMSE scores were higher at 7 days postoperatively,but the difference was not statistically significant(P>0.05).While the observation group had significantly higher MMSE scores at 24 h postoperatively compared to the control group(P<0.05),though the difference was not statistically significant at 48 h and 7 d postoperatively(P>0.05).Compared to T0,both groups showed significantly reduced cerebral oxygen saturation(rSO_(2))and internal jugular venous oxygen saturation(SjvO_(2))levels at T1,with elevated lactic acid(Lac)levels(P<0.05).At T2,rSO_(2) and SjvO_(2) levels rebounded(though still below T0),while Lac levels decreased(though still above T0),with statistical significance(P<0.05).The observation group had higher rSO_(2) and SjvO_(2) levels and lower Lac levels at T1 and T2 compared to the control group(P<0.05).Compared to T0,cortisol(Cor),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)levels increased at T1 and T2 in the two groups(P<0.05).The observation group had lower Cor,IL-6,and TNF-αlevels at T1 and T2 compared to the control group(P<0.05).There was no significant difference in the total complication rate between the two groups(P>0.05).The observation group had lower average sevoflurane inhalation concentration and less total remifentanil usage compared to the control group(P<0.05),but there was no significant difference in cisatracurium usage between the two groups(P>0.05).Conclusion:General anesthesia combined with ultrasound-guided serratus anterior plane block can effectively alleviate postoperative pain,improve intraoperative cerebral oxygen metabolism and its balance,may protect early postoperative cognitive function without increasing the risk of complications,which has good clinical application value.
作者
张兴
代志明
朱博
毛琦
ZHANG Xing;DAI Zhiming;ZHU Bo;MAO Qi(Department of Anesthesiology,Xianyang First People’s Hospital,Xianyang 712000,China)
出处
《机器人外科学杂志(中英文)》
2025年第12期2066-2072,共7页
Chinese Journal of Robotic Surgery
基金
咸阳市重点研发计划项目(S2022-ZDYF-SF-1062)。
关键词
全身麻醉
超声引导前锯肌阻滞
机器人辅助手术
乳腺癌根治术
康复
General Anesthesia
Ultrasound-guided Serratus Anterior Muscle Block
Robot-assisted Surgery
Radical Mastectomy for Breast Cancer
Rehabilitation
