超声引导下胸部神经阻滞在乳腺癌改良根治术后多模式镇痛中的应用

发布时间：2018-03-02 22:20

本文选题：超声引导　切入点：胸部神经阻滞　出处：《临床麻醉学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的评价超声引导下胸部神经(pectoral nerves,PECS)阻滞在乳腺癌改良根治术后多模式镇痛中的有效性及安全性。方法择期行单侧乳腺癌改良根治术女性患者60例,年龄18~65岁,ASAⅠ或Ⅱ级。按随机数字表法分为两组:超声引导下PECS阻滞组(P组)和空白对照组(C组),每组30例。全身麻醉诱导后,P组患者在超声引导下实施PECS阻滞,给予0.375%罗哌卡因30ml;C组患者不给予PECS阻滞。两组患者术前均给予静脉注射氟比洛芬酯1mg/kg。两组患者在静-吸复合全身麻醉下完成手术。记录患者术毕苏醒即刻(术后0h)、术后3、6、12和24h静息状态下疼痛VAS评分;并记录术中瑞芬太尼用量、术后24h内补救性镇痛药给予情况及术后不良反应发生情况。结果术后0、3、6和12hVAS评分P组明显低于C组(P0.05),术后24h两组VAS评分差异无统计学意义。术中瑞芬太尼用量P组明显少于C组,术后24h内镇痛药补救率P组明显低于C组(P0.05)。两组患者术后不良反应差异无统计学意义。结论对于乳腺癌改良根治术患者,超声引导胸部神经阻滞作为多模式镇痛模式的辅助,可以提供更佳的术后镇痛效果,且安全可靠。
[Abstract]:Objective to evaluate the ultrasound guided thoracic nerves (pectoral nerves, PECS) the efficacy and safety of anesthesia in modified radical mastectomy for multimodal analgesia. Methods patients undergoing unilateral modified radical mastectomy for breast cancer in 60 cases of female patients, aged 18~65 years old, ASA grade I or II. Were randomly divided into two group: Ultrasound guided PECS anesthesia group (P group) and control group (C group), 30 cases in each group. After induction of anesthesia, P group in the implementation of PECS block under ultrasound guidance with 0.375% ropivacaine 30ml; C group were not given PECS block. Two groups were given intravenous injection of fluoride flurbiprofen 1mg/kg. in the patients of the two groups of static absorption compound under general anesthesia to complete the operation. Postoperative recovery were recorded immediately (after 0h), postoperative 3,6,12 and 24h in resting state VAS pain scores were recorded; and the dosage of remifentanil, 24h postoperative recovery analgesics given situation The occurrence of adverse reactions and postoperative results. Postoperative 0,3,6 and 12hVAS score of P group was significantly lower than C group (P0.05), there were no significant differences in 24h VAS score of two groups after operation. The consumption of remifentanil in P group was significantly less than group C, 24h postoperative analgesic recovery rate of group P was significantly lower than that of group C (P0.05). No significant adverse reactions between the two groups of patients after radical resection. Conclusion for patients with breast cancer modified ultrasound assisted guided thoracic nerve block as multimodal analgesia mode, can provide a better analgesic effect after operation, safe and reliable.

【作者单位】：西安交通大学第一附属医院麻醉科;
【基金】：陕西省国际科技合作与交流计划(2014KW21-03)
【分类号】：R614;R737.9

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