机器人外科学杂志（中英文）2025，Vol.6Issue(1)：45-52,8.DOI:10.12180/j.issn.2096-7721.2025.01.009
机器人辅助下乳腺癌根治术患者行超声引导下Ⅱ型胸神经阻滞术后镇痛效果及影响因素
Postoperative analgesic effect and influencing factors of ultrasound-guided pectoral nerve block type Ⅱ in patients undergoing robot-assisted radical mastectomy
摘要
Abstract
Objective:To analyze the postoperative analgesic effect and influencing factors of ultrasound-guided pectoral nerve block type Ⅱ(PECS Ⅱ)in patients undergoing robot-assisted radical mastectomy.Methods:A prospective study was conducted.80 patients who underwent robot-assisted radical mastectomy in the Northwest Women and Children's Hospital from Feb.2023 to Aug.2024 were selected and divided into the control group[thoracic paravertebral nerve block(TPVB),n=40]and the observation group(ultrasound-guided PECS Ⅱ block,n=40)using a random number table.The postoperative recovery and sufentanil dosage,visual analogue scale(VAS)scores at different timepoints(1,5,8,and 12 h after surgery),and inflammatory indicators[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]before and 12 h after surgery were compared between the two groups.The factors affecting analgesic effect after robot-assisted radical mastectomy were analyzed.Results:Compared with the control group,the time of postoperative analgesia was longer,the time of spontaneous breathing recovery,removal of the laryngeal mask and full awakening were shorter,and the dosage of sufentanil was less in the observation group than those in the control group(P<0.05).At 12 h after surgery,the levels of TNF-α and IL-6 in the two groups were higher than those before surgery,and they were relatively lower in the observation group(P<0.05).VAS scores in both groups at 5,8,and 12 h after operation were higher than those at 1 h after operation and exhibited an upward trend.The VAS scores of the observation group at each timepoint were lower than those of the control group(P<0.05).At 12 h after surgery,VAS scores showed that 27 cases had poor analgesic effect and 53 cases had good analgesic effect.In the poor analgesic effect group,the proportion of patients with tumors located in the upper quadrant,preoperative anxiety or depression,and levels of serum TNF-α and IL-6 were higher than the good analgesic effect group(P<0.05).Regression analysis showed that preoperative anxiety or depression and high expression of serum TNF-α and IL-6 were factors affecting the analgesic effect after robot-assisted radical mastectomy(OR>1,P<0.05).Conclusion:Ultrasound-guided PECS II block can effectively prolong the postoperative analgesia in patients undergoing robot-assisted radical mastectomy,reduce the dosage of anesthetic drugs,and lower the postoperative inflammatory response.Preoperative anxiety or depression and serum TNF-α and IL-6 levels are closely related to postoperative pain.关键词
乳腺癌根治术/机器人辅助手术/镇痛效果/超声引导/胸神经阻滞/Ⅱ型胸神经Key words
Ridical Mastectomy/Robot-assisted Surgery/Analgesic Effect/Ultrasound-guiding/Pectoral Nerve Block/Type Ⅱ Pectoral Nerves分类
医药卫生引用本文复制引用
李珍,徐嘉蕾,丁亮..机器人辅助下乳腺癌根治术患者行超声引导下Ⅱ型胸神经阻滞术后镇痛效果及影响因素[J].机器人外科学杂志（中英文）,2025,6(1):45-52,8.基金项目
陕西省自然科学基金项目(2019JM-sf-089) Natural Science Foundation of Shaanxi Province(2019JM-sf-089) （2019JM-sf-089）
