目的：分析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（PECS Ⅱ）术后镇痛效果及影响 因素。方法：采取前瞻性研究，选取 2023 年 2 月—2024 年 8 月于西北妇女儿童医院收治的 80 例行机器人辅助下 乳腺癌根治术患者作为研究对象，按随机数字表法分为对照组（40 例，采取胸椎旁神经阻滞）和观察组（40 例， 采取超声引导下 PECS Ⅱ）。比较两组患者术后恢复情况及舒芬太尼用量，不同时点（术后 1 h、5 h、8 h、12 h） 采用视觉模拟评分法（VAS）评分；术前、术后 12 h 炎症指标 TNF-α、IL-6；分析影响机器人辅助下乳腺癌根治术 患者术后镇痛效果的因素。结果：观察组术后镇痛时间长于对照组，自主呼吸恢复、拔除喉罩、完全清醒时间短于 对照组，舒芬太尼用量少于对照组（P<0.05）；术后 12 h，两组患者 TNF-α、IL-6 水平均高于术前，且观察组低于 对照组（P<0.05）；术后 5 h、8 h、12 h，两组患者 VAS 评分均高于术后 1 h，并呈上升趋势，观察组各时点 VAS 评分均低于对照组（P<0.05）；术后 12 h，采用 VAS 评分评估患者镇痛效果，其中镇痛效果可或差 27 例，镇痛效 果优或良 53 例，镇痛效果可差组肿瘤部位为上象限、术前焦虑或抑郁患者占比高于镇痛效果优良组，血清 TNF-α、 IL-6 水平高于镇痛效果优良组（P<0.05）；回归分析显示，术前焦虑或抑郁、血清 TNF-α、IL-6 高表达为影响机 器人辅助下乳腺癌根治术患者镇痛效果的因素（OR>1，P<0.05）。结论：超声引导下 PECS Ⅱ能够有效延长机器 人辅助下乳腺癌根治术患者术后镇痛时间，减少麻醉药物用量，减轻患者术后炎症反应，且术前焦虑或抑郁、血清 TNF-α、IL-6 水平与患者术后疼痛密切相关。

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.

基金项目：陕西省自然科学基金项目（2019JM-sf-089） 

Foundation Item: Natural Science Foundation of Shaanxi Province (2019JM-sf-089)  

通讯作者：丁亮，Email：285459392@qq.com 

Corresponding Author: DING Liang, Email: 285459392@qq.com 

引用格式：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. 

Citation: LI Z, XU J L, DING L. Postoperative analgesic effect and influencing factors of ultrasound-guided pectoral nerve block  type Ⅱ in patients undergoing robot-assisted radical mastectomy[J]. Chinese Journal of Robotic Surgery, 2025, 6(1): 45-52.

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