胸椎旁神经阻滞联合全身麻醉对乳腺癌手术患者术后早期康复的影响  

Effect of thoracic paravertebral block combined with general anesthesia on early postoperative recovery in patients undergoing breast cancer surgery

作　　者：王蕾[1] 白冰[1] 裴丽坚[1] 谭刚[1] 张志永[1] 李旭[1] 黄宇光[1] Wang Lei;Bai Bing;Pei Lijian;Tan Gang;Zhang Zhiyong;Li Xu;Huang Yuguang(rtment of Anesthesiology, Peking Union Medical College Hospital Chinese Academy of Medical Sciences ＆ Pecking Union Medical College, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,100730

出　　处：《中华麻醉学杂志》2018年第3期320-323,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价胸椎旁神经阻滞联合全身麻醉对乳腺癌手术患者术后早期康复的影响。方法择期行手术治疗的原发、初治乳腺癌患者201例，年龄18-69岁，BMI〈35 kg/m^2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组：全身麻醉组（GA组，n＝102）和胸椎旁神经阻滞联合全身麻醉组（TGA组，n＝99）。术前30 min TGA组在超声引导下行胸椎旁神经阻滞，于T1-5每个穿刺点注射0.75%罗哌卡因5 ml；GA组每个穿刺点注射1%利多卡因0.2 ml进行局部浸润麻醉。静脉注射芬太尼、丙泊酚和罗库溴铵诱导麻醉；GA组吸入七氟醚，TGA组靶控输注丙泊酚，2组间断静脉注射芬太尼和罗库溴铵维持麻醉。术中维持BIS值40-60。术后采用主诉疼痛程度评分法评估疼痛程度，主诉疼痛程度评分〉4分时选择性静脉注射帕瑞昔布钠40 mg或哌替啶50 mg或曲马多50 mg或芬太尼50 μg补救镇痛。记录术后2 d内补救镇痛和恶心、干呕/呕吐的发生情况。分别于术后1和2 d时，采用中文版康复质量评分量表评估患者术后早期康复质量。结果与GA组比较，TGA组术后1和2 d时康复质量评分升高，术后恶心发生率降低（P〈0.05），术后补救镇痛率和干呕/呕吐发生率差异无统计学意义（P〉0.05）。结论相对于单纯全身麻醉而言，胸椎旁神经阻滞联合全身麻醉用于乳腺癌手术患者，有利于术后早期康复。Objective To evaluate the effect of thoracic paravertebral block （TPVB） combined with general anesthesia on early postoperative recovery in patients undergoing breast cancer surgery.Methods A total of 201 patients with untreated primary breast cancer, aged 18-69 yr, with body mass index 〈35 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective surgery for treatment, were enrolled and randomly assigned to general anesthesia group （group GA, n=102） and TPVB combined with general anesthesia group （group TGA, n=99）. In group TGA, TPVB was performed under ultrasound guidance at 30 min before surgery, and 0.75% ropivacaine 5 ml was injected at each puncture site of T1-5.In group GA, local infiltration anesthesia was performed with 1% lidocaine 0.2 ml at each puncture site.Anesthesia was induced with IV fentanyl, propofol and rocuronium in both groups.Anesthesia was maintained by inhaling sevoflurane （group GA）, target-controlled infusion of propofol （group TGA） and intermittent IV boluses of fentanyl or rocuronium.Bispectral index value was maintained at 40-60 during surgery.Verbal Rating Scale score was used to assess the severity of pain after surgery.Parecoxib sodium 40 mg, pethidine 50 mg, tramadol 50 mg or fentanyl 50 μg was selected and intravenously injected as rescue analgesics when Verbal Rating Scale pain score〉4.The requirement for rescue analgesia and development of nausea and retching/vomiting were recorded within 2 days after surgery.Chinese quality of recovery score was used to assess the early postoperative quality of recovery on days 1 and 2 after surgery.Results Compared with group GA, the quality of recovery score was significantly increased on days 1 and 2 after surgery, the incidence of postoperative nausea was decreased （P〈0.05）, and no significant change was found in the requirement for rescue analgesia or incidence of retching/vomiting after surgery in group TGA （P〉0.05）.Conclusion TPVB combined with general anesth

关 键 词：神经传导阻滞 胸椎 麻醉 全身 康复 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]