超声引导下间隔平面胸椎旁阻滞联合TIVA应用于乳腺癌改良根治术对术后疼痛的影响

发布时间：2018-03-28 17:54

本文选题：胸椎旁阻滞　切入点：超声引导　出处：《第三军医大学学报》2015年18期

【摘要】：目的评估超声引导下间隔平面胸椎旁阻滞联合全凭静脉麻醉(total intravenous anesthesia,TIVA)用于乳腺癌改良根治术对术后疼痛的影响。方法 60例行乳腺癌根治术18~85岁女性患者,ASAⅠ~Ⅲ级,按随机数字表法分为2组,每组30例。静吸复合组行静吸复合全身麻醉,胸椎旁阻滞组行多平面胸椎旁阻滞联合TIVA,术中自主呼吸。2组术后镇痛均采用患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)。在T1(入室时)、T2(手术开始前即刻)、T3(切皮后5 min)、T4(腋窝清扫时)、T5(手术结束时)、T6(拔除喉罩时)、T7(转出PACU时)记录患者的心率、血压、脉搏氧饱和度(Sp O2)、呼气末二氧化碳(PETCO2)和脑电双频谱指数(bispectral index,BIS);在T8(术后2 h)、T9(术后4 h)、T10(术后8 h)、T11(术后16 h)、T12(术后24 h)对患者进行VAS疼痛评分。记录术中舒芬太尼用量,PACU停留时间,PCIA舒芬太尼用量和PCIA按压次数及术后麻醉相关并发症情况。结果在手术开始前即刻,胸椎旁阻滞组心率明显高于静吸复合组,在手术结束时,胸椎旁阻滞组心率明显低于静吸复合组(P0.05)。血压、Sp O2、PETCO2和BIS在各时间点差异无统计学意义(P0.05)。胸椎旁阻滞组在术后2、4 h和术后8 h平静休息和咳嗽时VAS评分均低于静吸复合组。胸椎旁阻滞组的术中舒芬太尼用量、PACU停留时间、PCIA舒芬太尼用量和按压次数均低于静吸复合组(P0.05)。胸椎旁阻滞组术后麻醉相关并发症发生例数少于静吸复合组,但2组发生率差异无统计学意义(P0.05)。结论超声引导下胸椎旁阻滞可安全有效的应用于乳腺癌改良根治术,不仅可以有效减少围术期阿片类药物的用量,降低PACU停留时间,而且能改善术后急性疼痛,有利于患者术后恢复。
[Abstract]:Objective to evaluate the effect of total intravenous anesthesia combined with total total intravenous anesthesia on postoperative pain after radical mastectomy in 60 women (1885 years old) undergoing radical mastectomy. According to the method of random digital table, the patients were divided into two groups, 30 cases in each group, and 30 cases in each group. In the paraspinal thoracic block group, the patient controlled intravenous analgesia was used for postoperative analgesia with patient-controlled intravenous analgesia. At the end of the operation, the heart rate of the patient was recorded. Blood pressure, Pulse oxygen saturation (SPO _ 2), end-expiratory carbon dioxide (PETCO _ 2) and bispectral index (bispectral index) were used in T8 (2 h after operation) and T9 (4 h after operation). The pain scores of VAS were assessed at 8 h after operation (16 h after operation) and 24 h after operation. The dosage of sufentanil was recorded during operation. The duration of stay, the dosage of sufentanil, the number of PCIA compressions, and the complications associated with anesthesia after operation. The heart rate of thoracic paravertebral block group was significantly higher than that of static aspiration group, and at the end of operation, The heart rate of thoracic paravertebral block group was significantly lower than that of static aspiration combined group (P 0.05). There was no significant difference in blood pressure, spo _ 2, PETCO _ 2 and BIS at different time points. The VAS score of thoracic paraspinal block group was lower than that of rest and cough group at 24 h and 8 h after operation. The dosage of sufentanil and the residence time of PACU in the thoracic paravertebral block group were lower than those in the control group (P 0.05). The incidence of postoperative anesthetic complications in the paravertebral thoracic block group was less than that in the control group. Conclusion Ultrasound-guided paravertebral block can be used safely and effectively in modified radical mastectomy for breast cancer. It can not only reduce the dosage of opioid drugs during perioperative period, but also reduce the residence time of PACU. Moreover, it can improve the acute pain after operation, and is beneficial to the recovery of patients after operation.
【作者单位】：南方医科大学南方医院麻醉科;
【分类号】：R737.9;R614

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