艾司氯胺酮神经周围注射对乳腺癌改良根治术患者的术后镇痛效果分析

庞希友; 廖俊峰; 徐潮阳

doi:10.16766/j.cnki.issn.1674-4152.003915

艾司氯胺酮神经周围注射对乳腺癌改良根治术患者的术后镇痛效果分析

doi: 10.16766/j.cnki.issn.1674-4152.003915

1.
金华市中心医院麻醉科，浙江金华 321000
2.
金华市中心医院乳甲外科

基金项目:

浙江省基础公益研究计划项目 LTGG24H310001

详细信息

通讯作者:
庞希友，E-mail：lxlpqt@163.com

中图分类号: R614.27 R737.9
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出版历程
- 收稿日期: 2024-11-11
- 网络出版日期: 2025-05-14

Analgesic effect of paraneural injection of Esketamine on patients undergoing modified radical mastectomy for breast cancer

1.
Department of Anesthesiology, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China

摘要

摘要: 目的探讨艾司氯胺酮神经周围注射对乳腺癌改良根治术患者的术后镇痛效果，为临床制定术后镇痛方案提供参考。方法将2022年1月—2024年7月金华市中心医院收治的115例乳腺癌改良根治术患者依据随机数表法分成A组(57例)与B组(58例)，A组不进行神经周围注射，B组给予神经周围注射艾司氯胺酮+罗哌卡因。观察2组患者的术后恢复质量[15项恢复质量量表(QoR-15) 评分]、炎症因子水平[白细胞介素(IL-6)、肿瘤坏死因子-α(TNF-α)]、术后镇痛效果(VAS评分)、睡眠质量[匹兹堡睡眠质量指数(PSQI)]、不良反应(恶心、呕吐、头晕、谵妄)发生情况。结果 B组术后72 h的QoR-15评分[(107.42±7.46)分]高于A组[(102.17±6.95)分，P＜0.05]。2组术后IL-6、TNF-α均呈下降趋势，且B组下降幅度更大(P＜0.05)。2组术后静态、动态的VAS评分均呈升高趋势，但B组升高幅度更小(P＜0.05)。B组术后72 h的PSQI评分[(7.15±1.24)分]低于A组[(8.23±1.41)分，P＜0.05]。B组不良反应发生率为8.62%(5/58)，A组为12.28%(7/57)，2组比较差异无统计学意义(χ²=0.408，P=0.523)。结论艾司氯胺酮神经周围注射能够提高乳腺癌改良根治术患者的术后恢复质量，降低炎症反应，减轻术后疼痛感受，改善睡眠质量。
- 艾司氯胺酮 /
- 神经周围注射 /
- 乳腺癌改良根治术 /
- 术后镇痛
Abstract: Objective To explore the postoperative analgesic effect of paraneural injection of Esketamine in patients undergoing modified radical mastectomy modified radical mastectomy for breast cancer, and to provide reference for clinical formulation of postoperative analgesia program. Methods A total of 115 modified radical mastectomy patients admitted to Jinhua Central Hospital from January 2022 to July 2024 were randomly divided into group A (n=57) and group B (n=58) using a random number table method. Group A did not receive perineural injections, while group B received perineural injections of ketamine and ropivacaine. The postoperative recovery quality [15-item quality of recovery (QoR-15)], inflammatory factor levels [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], postoperative analgesic effect (VAS score), sleep quality [Pittsburgh sleep quality index (PSQI)], and adverse reactions (nausea, vomiting, dizziness, delirium) of two groups were observed. Results The QoR-15 score in group B [(107.42±7.46) points] was higher than that in group A [(102.17±6.95) points] 72 hours after surgery (P<0.05). The postoperative levels of IL-6 and TNF-α in both groups showed a decreasing trend, with group B showing a greater decrease (P<0.05). The static and dynamic VAS scores of both groups showed an increasing trend after surgery, but the increase in group B was smaller (P<0.05). The PSQI score of group B at 72 hours after surgery [(7.15 ±1.24) points] was lower than that of group A [(8.23±1.41) points, P<0.05]. The incidence of adverse reactions was 8.62% (5/58) in group B and 12.28% (7/57) in group A, and there was no significant difference between the two groups (χ²=0.408, P=0.523). Conclusion Paraneural injection of Esketamine can improve the quality of postoperative recovery, reduce inflammatory reactions, alleviate postoperative pain, and improve sleep quality in modified radical mastectomy patients, which is worthy of application.
- Esketamine /
- Perineural injection /
- Modified radical mastectomy for breast cancer /
- Postoperative analgesic

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表 1 2组乳腺癌改良根治术患者术后恢复质量比较(x±s, 分)

Table 1. Comparison of quality of recovery after modified radical mastectomy between two groups (x±s, points)

组别	例数	QoR-15
组别	例数	术后24 h	术后72 h
A组	57	86.41±5.63	102.17±6.95
B组	58	85.97±5.32	107.42±7.46
统计量		0.431^a	4.221^b
P值		0.667	＜0.001
注：^a为t值，^b为F值。

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表 2 2组乳腺癌改良根治术患者炎症因子水平比较(x ±s，pg/L)

Table 2. Comparison of inflammatory factors between the two groups of breast cancer patients with modified radical mastectomy (x ±s, pg/L)

组别	例数	IL-6			TNF-α
组别	例数	术前24 h	术后24 h	术后72 h	术前24 h	术后24 h	术后72 h
A组	57	17.81±2.58	56.25±4.31	38.43±3.79	4.19±0.62	16.36±1.57	13.02±1.14
B组	58	18.25±2.63	55.08±4.57	36.54±3.25	4.12±0.56	15.83±1.62	12.37±1.09
F值		0.906	1.413	2.869	0.635	1.782	3.124
P值		0.367	0.161	0.005	0.527	0.078	0.002

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表 3 2组乳腺癌改良根治术患者术后VAS评分比较(x±s，分)

Table 3. Comparison of postoperative VAS scores between the two groups of breast cancer patients with modified radical mastectomy (x±s, points)

组别	例数	静态				动态
组别	例数	术后6 h	术后9 h	术后12 h	术后24 h	术后6 h	术后9 h	术后12 h	术后24 h
A组	57	1.65±0.59	2.23±0.71	2.91±0.85	3.14±0.53	1.96±0.68	2.48±0.76	3.02±0.73	3.29±0.57
B组	58	1.68±0.62	1.85±0.67	2.42±0.74	2.96±0.51	1.87±0.73	2.12±0.69	2.57±0.65	3.14±0.61
F值		0.266	2.951	3.295	1.855	0.684	2.658	3.489	1.363
P值		0.791	0.004	0.001	0.066	0.495	0.009	0.001	0.176

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表 4 2组乳腺癌改良根治术患者睡眠质量比较(x±s，分)

Table 4. Comparison of sleep quality between two groups of patients with modified radical mastectomy for breast cancer (x±s, points)

组别	例数	PSQI
组别	例数	术后24 h	术后72 h
A组	57	14.61±2.67	8.23±1.41
B组	58	14.97±2.58	7.15±1.24
统计量		0.735^a	4.637^b
P值		0.464	＜0.001
注：^a为t值，^b为F值。

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