目的:探讨超声引导下胸椎旁阻滞联合全身麻醉对乳腺癌改良根治术后疼痛相关介质分泌的影响.方法:选择在本院接受乳腺癌改良根治术治疗的乳腺癌患者108例,经随机数表法分为对照组、椎旁阻滞组各54例.对照组接受常规全身麻醉,椎旁阻滞组患者接受超声引导下胸椎旁阻滞联合全身麻醉.对比两组患者手术结束即刻(T0)、术后6 h(T1)、术后12 h(T2)、术后24 h(T3)血清中疼痛介质、炎症因子、应激激素含量的差异.结果:T0时,两组血清中疼痛介质、炎症因子、应激激素含量的差异无统计学意义.T1、T2、T3时,椎旁阻滞组血清中疼痛介质NPY、PGE2、5-HT的含量低于对照组;血清中炎症因子IL-1、IL-6、TNF-α、MCP-1的含量低于对照组;血清中应激激素ACTH、Cor、AngⅠ 、AngⅡ的含量低于对照组.结论:乳腺癌改良根治术患者接受超声引导下胸椎旁阻滞联合全身麻醉,可有效减轻患者术后疼痛介质的释放,减轻全身炎症应激反应.%Objective:To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy .Methods:A total of 108 patients with breast cancer who were treated with modified radical mastectomy in this hospital between July 2015 and February 2017 were di-vided into the control group (n=54) and paravertebral block group (n=54) by random number table .Control group received routine general anesthesia ,and paravertebral block group received ultrasound-guided thoracic paravertebral block combined with general anesthesia .The differences in serum levels of pain mediators ,inflammatory factors and stress hormones were compared between the two groups of patients immediately after surgery (T0) ,6h after surgery (T1) ,12h after surgery (T2) and 24h after surgery (T3) .Results:At T0 ,there was no statistically significant difference in serum levels of pain mediators , inflammatory factors and stress hormones between the two groups .At T1 ,T2 and T3 ,serum pain mediators NPY ,PGE2 and 5-HT levels of paravertebral block group were lower than those of control group ;serum inflammatory factors IL-1 ,IL-6 ,TNF-αand MCP-1 levels were lower than those of control group ;serum stress hormones ACTH ,Cor ,AngⅠ and AngⅡ lev-els were lower than those of control group .Conclusion:ultrasound-guided thoracic paravertebral block combined with general anesthesia can effectively reduce the release of pain mediators and relieve the systemic inflammatory stress response after modi-fied radical mastectomy .
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