| 喻晓敏,王 珊,李玉珍,孔俊丽,吴清海.地塞米松联合罗哌卡因ESP阻滞对老年乳腺癌根治术患者术后疼痛的影响[J].,2024,(9):1778-1782 |
| 地塞米松联合罗哌卡因ESP阻滞对老年乳腺癌根治术患者术后疼痛的影响 |
| Effect of Dexamethasone Combined with Ropivacaine ESP Block on Pain in Elderly Patients after Radical Mastectomy for Breast Cancer |
| 投稿时间：2023-11-08 修订日期：2023-11-30 |
| DOI：10.13241/j.cnki.pmb.2024.09.035 |
| 中文关键词: 地塞米松 罗哌卡因 竖脊肌平面ESP阻滞 老年 乳腺癌根治术 术后疼痛 |
| 英文关键词: Dexamethasone Ropivacaine ESP block Elderly Radical mastectomy for breast cancer Postoperative pain |
| 基金项目:中国医药教育协会"聚火优才"全国药学服务科研项目（CMEAPC2023029） |
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| 中文摘要: |
| 摘要 目的：探讨地塞米松联合罗哌卡因竖脊肌平面（ESP）阻滞对老年乳腺癌根治术患者术后疼痛的效果。方法：选取2020年9月~2023年5月湖北省十堰市国药东风总医院收治的110例择期行乳腺癌根治术的老年女性患者作为研究对象，根据随机数字表法将其分为ESP组和对照组，各55例。对照组予以全身麻醉，ESP组在对照组基础上予以ESP阻滞。比较两组患者围术期指标、手术后1 h、6 h、12 h、24 h及48 h静息状态下数字疼痛评分（NRS）、手术前后血清5-羟色胺（5-HT）和前列腺素E2（PGE2）水平及术后不良反应的发生情况。结果：ESP组患者手术时间和下床活动时间明显短于对照组（P＜0.05），术中出血量少于对照组（P＞0.05），术后不同时点NRS评分均低于对照组（P＜0.05）；两组术后1 h、6 h、12 h、24 h及48 h NRS评分逐渐升高再降低，但ESP组各时点NRS评分均低于对照组，ESP组随时间变化降低幅度明显大于对照组，两组NRS评分组间、时间及交互比较，差异均有统计学意义（P＜0.05）。ESP组术后血清5-HT和PGE2水平明显低于对照组（P＜0.05）。ESP组头晕、恶心呕吐及皮肤瘙痒的发生率虽低于对照组，但差异无统计学意义（P＞0.05）。结论：地塞米松联合罗哌卡因ESP阻滞应用于老年乳腺根治术可有效减轻患者术后疼痛，其镇痛效果可能与降低5-HT和PGE2水平有关，且该方案安全性高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of dexamethasone combined with ropivacaine ESP block on pain in elderly patients after radical mastectomy for breast cancer. Methods: A total of 110 elderly female patients who underwent elective radical mastectomy for breast cancer in Shiyan Dongfeng General Hospital, Hubei Province from September 2020 to May 2023were selected as the research subjects. They were divided into ESP group and control group according to random number table, with 55 cases in each group. The control group received general anesthesia, while ESP group received ESP block. The two groups were compared on perioperative indicators, NRS scores in resting state at 1 h, 6 h, 12 h, 24 h and 48 h after operation, serum 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) levels before and after operation, and occurrence of postoperative adverse reactions. Results: Comparison between the groups found that operation time and ambulation time of ESP group was significantly shorter(P<0.05). Intraoperative blood loss of ESP group was less(P>0.05). NRS scores of both groups gradually increased and then decreased at 1 h, 6 h, 12 h, 24 h and 48 h after operation. The NRS score of ESP group was lower than that of the control group at each time point. The decreases in ESP group were significantly greater than those in control group over time. There were statistically significant differences in NRS scores in terms of inter-group effect, time effect and interaction effect(P<0.05). After operation, serum 5-HT and PGE2 levels in ESP group were significantly lower (P<0.05). The incidence rates of dizziness, nausea and vomiting, and skin pruritus were lower in ESP group, but there was no statistically significant difference compared to control group(P>0.05). Conclusion: Applying dexamethasone combined with ropivacaine ESP block to elderly patients undergoing radical mastectomy for breast cancer can effectively alleviate postoperative pain. The analgesic effect may be related to reduction of 5-HT and PGE2 levels. In addition, this analgesic mode is highly safe. |
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