全麻复合肋间神经阻滞对乳腺癌改良根治术后镇痛效果的影响

发布时间：2018-05-31 13:24

本文选题：肋间神经阻滞 + 联合麻醉　；参考：《中国癌症杂志》2015年07期

【摘要】：背景与目的:许多患者在单纯全麻下行乳腺癌改良根治术后会出现急性疼痛。该研究旨在探讨全麻复合肋间神经阻滞是否可减轻乳腺癌改良根治术后急性疼痛的程度。方法:选择择期行乳腺癌改良根治术的患者96例,使用随机数字表法随机分为单纯全麻组(G组)和全麻复合肋间神经阻滞组(C组)。G组直接行全身麻醉;C组则在麻醉诱导前在超声辅助下经腋中线入路行肋间神经阻滞,当神经阻滞起效后再行全身麻醉。两组患者全麻诱导用药相同,当术中血压或心率大于基础值20%时追加舒芬太尼10μg。苏醒期追加舒芬太尼直至VAS评分为0。记录术中及术后舒芬太尼用量和患者术后2(T1)、12(T2)和24 h(T3)静息时痛觉VAS评分以及术后2和24 h恶心、呕吐的发生率。结果:两组患者在年龄、体质量指数、手术时间等方面差异无统计学意义。术中及术后C组患者舒芬太尼用量分别为(25.2±3.5)和(3.3±1.2)μg,G组分别为(40.5±4.3)和(8.4±2.2)μg,两组比较,C组均明显少于G组,差异有统计学意义(P0.01);T1、T2和T3各时点C组患者VAS评分分别为(0.45±0.15)、(1.75±0.08)和(2.05±0.12)分,G组患者VAS评分分别为(4.32±0.21)、(4.88±0.13)和(4.78±0.16)分,两组比较,C组均明显低于G组,差异有统计学意义(P0.01);术后2和24 h各时点C组恶心、呕吐发生率分别为6.25%和16.66%,G组分别为20.8%和41.66%,两组比较,C组均明显低于G组,差异有统计学意义(P0.01)。C组患者无1例出现肋间神经阻滞并发症。结论:与单纯全麻相比,全麻复合肋间神经阻滞可显著减少术中及术后阿片类药物用量,减轻乳腺癌改良根治术患者术后急性疼痛的程度,降低术后恶心、呕吐的发生率。超声辅助下进行肋间神经阻滞可提高操作的安全性和准确性,提高患者的满意度。
[Abstract]:Background & objective: acute pain occurs in many patients after modified radical mastectomy under general anesthesia alone. The aim of this study was to investigate whether general anesthesia combined with intercostal nerve block can alleviate acute pain after modified radical mastectomy for breast cancer. Methods: 96 patients with breast cancer undergoing modified radical mastectomy were selected. The method of random number table was used to divide into two groups: group G (simple general anesthesia) and group C (general anesthesia combined with intercostal nerve block). Group C (group C) received general anesthesia directly before anesthesia induction and intercostal nerve block was performed via the midaxillary approach assisted by ultrasound before anesthesia induction. General anesthesia is performed when the nerve block takes effect. The two groups had the same general anesthesia induction medication, and 10 渭 g sufentanil was added when the blood pressure or heart rate was higher than the basic value of 20. During recovery, sufentanil was added until the VAS score was 0. The VAS score of pain sensation and the incidence of nausea and vomiting at 2 and 24 hours after operation were recorded. Results: there was no significant difference in age, body mass index and operation time between the two groups. The dosage of sufentanil in group C and group C were 25.2 卤3.5) and 3.3 卤1.2) 渭 g / g respectively (40.5 卤4.3) and 8.4 卤2.2) 渭 g, respectively. The dosage of sufentanil in group C was significantly lower than that in group G (P < 0.05). The VAS scores of group C and G were 0.45 卤0.15 卤0.08 and 2.05 卤0.12, respectively. The VAS scores of group G were 4.32 卤0.21, 4.88 卤0.13) and 4.78 卤0.16, respectively. The scores of VAS in group C were significantly lower than those in group G. The incidence of nausea and vomiting was 6.25% in group C and 20.8% in group G and 41.66% in group G at 2 and 24 hours after operation, respectively. The incidence of nausea and vomiting in group C was significantly lower than that in group G at 2 and 24 hours after operation, and the incidence of nausea and vomiting in group C was significantly lower than that in group G at 2 and 24 hours after operation. There was no complication of intercostal nerve block in group C (P 0.01). Conclusion: compared with general anesthesia combined with intercostal nerve block, general anesthesia combined with intercostal nerve block can significantly reduce the dosage of opioid drugs during and after operation, reduce the degree of postoperative acute pain in patients with modified radical mastectomy, and reduce the incidence of postoperative nausea and vomiting. Ultrasound-assisted intercostal nerve block can improve the safety and accuracy of operation and improve patient satisfaction.
【作者单位】：复旦大学附属肿瘤医院麻醉科复旦大学上海医学院肿瘤学系;
【基金】：国家自然科学基金资助项目(N5FC81471852) 上海市自然科学基金资助项目(KW1307)
【分类号】：R614;R737.9

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