多模式镇痛在乳腺癌围术期的应用  

Multimodal analgesia in perioperative period of modified radical mastectomy

作　　者：韩洁[1] 汪春英[1] 

机构地区：[1]上海市黄浦区中心医院麻醉科,上海200002

出　　处：《上海医学》2016年第6期345-349,共5页Shanghai Medical Journal

基　　金：上海市黄浦区重点专科配套研究项目(麻醉专科建设配套课题1)

摘　　要：目的观察乳腺癌改良根治术围术期多模式镇痛的效果及其不良反应发生情况。方法选择择期行乳腺癌改良根治术的患者240例,随机分入4组,每组60例:舒芬太尼患者静脉自控镇痛(PCIA)组(对照组),舒芬太尼+丙帕他莫PCIA组(联合用药组),丙帕他莫预防性镇痛+舒芬太尼PCIA组(丙帕他莫预防性镇痛组),帕瑞昔布预防性镇痛+舒芬太尼PCIA组(帕瑞昔布预防性镇痛组)。分别于术后1、3、6、12、24、48h各时间点,记录患者的疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分、BCS(Bruggrmann comfort scale)舒适度评分;记录患者术后48h内的PCIA按压次数和术后不良反应发生情况。结果联合用药组、丙帕他莫预防性镇痛组和帕瑞昔布预防性镇痛组术后1、3、6、12、24、48h的疼痛VAS评分均显著低于对照组同时间点(P值均<0.01);丙帕他莫预防性镇痛组术后1、3h的疼痛VAS评分均显著低于联合用药组同时间点(P值分别<0.05、0.01),术后12、48h的疼痛VAS评分均显著高于联合用药组同时间点(P值分别<0.05、0.01);帕瑞昔布预防性镇痛组术后1、24、48h的疼痛VAS评分均显著高于联合用药组同时间点(P值分别<0.05、0.01),术后1、3、6、24、48h的疼痛VAS评分均显著高于丙帕他莫预防性镇痛组同时间点(P值分别<0.05、0.01)。除联合用药组和帕瑞昔布预防性镇痛组术后24h外,3组其他各时间点的BCS舒适度评分均显著高于对照组同时间点(P值分别<0.05、0.01),丙帕他莫预防性镇痛组术后1、3、6、12、24h和帕瑞昔布预防性镇痛组术后6h的BCS舒适度评分均显著高于联合用药组同时间点(P值分别<0.05、0.01);帕瑞昔布预防性镇痛组术后1、3、12、24、48h的BCS舒适度评分均显著高于丙帕他莫预防性镇痛组同时间点(P值分别<0.05、0.01)。4组各时间点间Ramsay镇静评分的差异均无统计学意义(P值均>0.05)。联合用药组、丙帕他莫预防性镇痛组和帕瑞昔布Objective To observe the outcomes and adverse reactions of multimodal analgesia in perioperative period of modified radical mastectomy. Methods A total of 240 patients scheduled for modified radical mastectomy were randomly divided into four groups （ n = 60）. Patients received patient controlled intravenous analgesia （PCIA） with sulfentanyl in control group. Patients received PCIA with sulfentanyl and propacetamol in group A. Patients received intravenous propacetamol for preemptive analgesia and sulfentanyl PCIA in group B. Patients received intravenous parecoxib for preemptive analgesia and sulfentanyl PCIA in group C. The visual analogue （VAS） score, Ramsay sedation score, Bruggrmann comfort scale （BCS） score, PCIA pressing times and incidence of adverse reactions were recorded at 1, 3, 6,12, 24, and 48 hours after operation. Results Compared with those in the control group, the VAS score.was significantly decreased in group A, B and C at 1, 3, 6,12, 24, and 48 h after operation （all P〈0.01）, while the BCS score was significantly increased （P〈0.05,0.01）in additon to group A and C at 24 hours after operation. The VAS score of group B was significantly lower than that of group A at 1 and 3 hours postoperatively （ P〈0.05, 0.01）, while the VAS score of group B was significantly higher than that of group A at 12 and 48 hours postoperatively （P〈0.05, 0.01）. The VAS score of group C was significantly higher than that of group A at 1, 24, and 48 hours postoperatively （P〈 0.05, 0.01）. The VAS score of group C was also significantly higher than that of group B at 1, 3, 6, 24, and 48 hours postoperatively（P〈0.05, 0.01）. The BCS score of group B at 1, 3, 6, 12, and 24 hours postoperatively and of group C at 6 hours postoperatively was significantly higher than that of group A （ P〈0.05, 0.01 ）. The BCS scores of group C was significantly higher than that of group.B at 1, 3, 12, 24, and 48 hours postoperatively （P〈 0.05, 0.01）. There was no significant differen

关 键 词：多模式镇痛 预防性镇痛 丙帕他莫 帕瑞昔布 舒芬太尼 乳腺癌 手术 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]