胸椎旁神经阻滞联合全身麻醉对乳腺癌手术患者远期生存质量的影响  

Effect of thoracic paravertebral block combined with general anesthesia on long-term quality of life in patients undergoing breast cancer surgery

作　　者：李旭[1] 裴丽坚[1] 谭刚[1] 张志永[1] 黄宇光[1] Li Xu;Pei Lijian;Tan Gang;Zhang Zhiyong;Huang Yuguang(Department of Anesthesiology, Peking Union Medical College Hospital Chinese Academy of Medical Science ＆ Peking 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324-327,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远期生存质量的影响。方法乳腺癌手术患者156例，年龄18-64岁，ASA分级Ⅰ或Ⅱ级，通过中央随机化网络系统按1∶1随机分为2组（n＝78）：胸椎旁神经阻滞联合全身麻醉组（TPVB＋GA组）和全身麻醉组（GA组）。TPVB＋GA组靶控输注丙泊酚（效应室浓度2.5-4.0 μg/ml），全身麻醉诱导前30 min，超声引导下予单次、多点（T1-T5）胸椎旁神经阻滞；GA组吸入2.0%-2.5%七氟醚。于术后6和12个月时采用改良版简明疼痛调查量表评估术后慢性疼痛及其影响日常生活的发生情况，采用简明神经病理性疼痛量表评估神经病理性疼痛发生情况，采用生活质量量表评估患者远期健康相关生存质量。结果2组术后6和12个月慢性疼痛及其影响日常生活的发生率、神经病理性疼痛发生率、生活质量量表评分比较差异无统计学意义（P〉0.05）。结论胸椎旁神经阻滞联合全身麻醉对乳腺癌手术患者远期生存质量无显著影响。Objective To evaluate the effect of thoracic paravertebral block （TPVB） combined with general anesthesia on the long-term quality of life in the patients undergoing breast cancer surgery.Methods A total of 156 patients, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing breast cancer surgery, were randomly assigned to TPVB combined with general anesthesia group （TPVB＋ GA group, n=78） and general anesthesia group （GA group, n = 78）, and the patients in two groups were matched with a ratio of 1∶1.In group TPVB＋ GA, propofol （target effect-site concentration 2.5-4.0 μg/ml） was given by target-controlled infusion, and patients received either single or multiple injections （T1-T5） of TPVB under ultrasound guidance at 30 min before induction of general anesthesia.Group GA inhaled 2.0%-2.5% sevoflurane.The patients were followed up at 6 and 12 months after operation, postoperative chronic pain and chronic pain affecting daily life were assessed using the modified Brief Pain Inventory, the development of neuropathic pain using neuropathic pain questionnaire-short form, and the development of long-term health-related quality of life by using the 12-item short-form scale.Results There was no significant difference in the incidence of chronic pain and chronic pain affecting daily life, incidence of neuropathic pain or quality of life scale score at 6 and 12 months postoperatively between the two groups （P〉0.05）.Conclusion TPVB combined with general anesthesia exerts no effect on the long-term quality of life in the patients undergoing breast cancer surgery.

关 键 词：胸椎 神经传导阻滞 麻醉 全身 乳腺肿瘤 生活质量 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]