舒芬太尼复合罗哌卡因肋间神经阻滞在乳癌手术中的应用  

Application of Sufentanil and Ropivacaine Intercostal Nerve Block in the Operation of Breast Cancer

作　　者：屈方方[1] 

机构地区：[1]江苏省建湖县人民医院麻醉科,江苏建湖224700

出　　处：《中国继续医学教育》2017年第33期44-47,共4页China Continuing Medical Education

摘　　要：目的研究舒芬太尼复合罗哌卡因肋间神经阻滞在乳癌手术中应用的效果,探讨乳癌手术更好的麻醉方案。方法选择我院接受乳癌改良根治术的择期手术患者90例,采用随机数字法分为对照组(A组)、罗哌卡因组(B组)、罗哌卡因+舒芬太尼组(C组)。A组直接行全身麻醉诱导;B组先行超声引导下0.375%罗哌卡因20 ml肋间神经阻滞,再行全身麻醉诱导;C组先行超声引导下0.375%罗哌卡因和舒芬太尼10μg混合液20 ml肋间神经阻滞,再行全身麻醉诱导。每组30例。记录手术过程中不同时段心率、血压、静脉用舒芬太尼总量,术后苏醒时间、术后不同时段VAS评分及不良反应情况。结果与A组比较,B组、C组术中舒芬太尼用量减少,在切皮、术中及拔喉罩时MAP、HR降低,自主呼吸恢复时间、苏醒时间、拔除喉罩时间缩短,术后2 h、4 h、24 h VAS评分减小,并发症发生率降低(P<0.05);与B组比较,C组术中舒芬太尼用量减少,在切皮、术中及拔喉罩时MAP、HR降低,术后自主呼吸恢复时间、苏醒时间、拔除喉罩时间缩短,术后4 h、24h VAS评分减小(P<0.05)。结论舒芬太尼复合罗哌卡因肋间神经阻滞增强乳癌手术全身麻醉效果,减少全麻药用量,缩短麻醉苏醒时间,且术后镇痛效果强、作用持续时间长,不良反应少。Objective To study the effect of sufentanil and ropivacaine intercostal nerve block in the operation of breast cancer, and explore a better anesthetic scheme for breast cancer surgery. Methods 90 patients undergoing elective surgery for modified radical mastectomy in our hospital were selected. The random number method was used to divide into the control group （group A）, ropivacaine group （group B）, ropivacaine ＋ sufentanil group （group C）. Group A was induced by direct general anesthesia. In group B, 0.375% ropivacaine was guided by 20 ml intercostal nerve block and then induced by general anesthesia. Group C was guided by 0.375% ropivacaine and sufentanil 10 μg mixed solution of 20 ml intercostal nerve block under the guidance of ultrasound, and then induced by general anesthesia, 30 cases in each group. The heart rate, blood pressure, total intravenous sufentanil, postoperative recovery time, VAS score at diferent time points and adverse reactions during operation were recorded. Results Compared with the A group, the dosage of sufentanil in group B and group C was reduced. MAP and HR were reduced in skin cutting, intraoperative and laryngeal mask, and the time of spontaneous respiration recovery, recovery time, and extraction of laryngeal mask were shortened. After operation, the scores of 2 h, 4 h and 24 h VAS decreased and the incidence of complications decreased （P 〈 0.05）. Compared with the B group, the dosage of sufentanil in group C was reduced. The decrease of MAP and HR in skin cutting, intraoperative and laryngeal mask, the recovery time of spontaneous breathing, the time of awakening, and the shortening of the extraction of laryngeal mask after operation. After operation, the score of 4 h and 24 h VAS decreased （P 〈 0.05）. Conclusion Sufentanil combined with ropivacaine intercostal nerve block enhances the efect of general anesthesia in breast cancer surgery, reduces the dosage of total anesthetics, shortens the time of anesthesia recovery, and has strong analgesic efect, l

关 键 词：舒芬太尼 罗哌卡因 肋间神经阻滞 乳癌改良根治术 

分 类 号：R728[医药卫生—儿科]