超声引导下胸壁神经阻滞与肋间神经阻滞用于乳腺癌术后镇痛的比较  

Efficacy of pectoral nerve block versus intercostal nerve block for postoperative analgesia after breast cancer surgery

作　　者：刘天啸[1] 李艳华[1] 陈静[2] 谢玉波[2] LIU Tian -xiao , LI Yan- hua, CHEN Jing, XIE Yu - bo.(Department of Anesthesiology, Traditional Chinese Medicine Hospital of Guilin City, Guilin 541002, Guangxi, Chin)

机构地区：[1]桂林市中医医院麻醉科,广西桂林541002 [2]广西医科大学第一附属医院麻醉科,广西南宁530021

出　　处：《广东医学》2018年第10期1501-1504,共4页Guangdong Medical Journal

基　　金：广西医疗卫生适宜技术开发与推广应用项目(编号:S2017039)

摘　　要：目的比较胸壁神经阻滞与传统的肋间神经阻滞在乳腺癌手术中的应用效果。方法将90例择期行单侧乳腺癌手术的患者,按随机数字表法分为3组:胸壁神经阻滞联合全麻组(P组)、肋间神经阻滞联合全麻组(I组)和单纯全麻组(G组)。记录术后3、6、12 h,1、2、3 d的疼痛数字评分(NRS)和恶心呕吐发生率(PONV);术中全麻药的用量;神经阻滞操作时间、并发症发生率。结果与G组比较,P组和I组NRS评分在术后3、6、12 h,1、2、3 d降低(P<0.05);PONV发生率在术后3、6、12 h降低(P<0.05);P组和I组丙泊酚和瑞芬太尼用量减少(P<0.05)。P组操作时间明显短于I组(P<0.05);P组和I组丙泊酚和瑞芬太尼用量、术后各时点NRS评分及PONV发生率比较差异无统计学意义(P>0.05),两组均未见并发症发生。结论胸壁神经阻滞与肋间神经阻滞均能明显减少术中全麻药用量,减轻患者术后疼痛及恶心呕吐;胸壁神经阻滞操作较肋间神经阻滞简便易行,适宜在临床推广应用。Objective To compare the efficacy and safety of ultrasound-guided pectoral nerve(Pecs） block with intercostal nerve block for perioperative analgesia for breast cancer surgery. Methods Ninety patients undergoing breast cancer surgery were randomized with random number into 3 groups. Patients in Group P received ultrasound-guided pectoral nerve block combined with general anesthesia. Patients in Group I received ultrasound-guided intercostal nerve block combined with general anesthesia. Patients in Group G received general anesthesia alone. Same induction of general anesthesia was applied in all the three groups. Postoperative pain was assessed using a numerical rating scale(NRS）. The vital signs and pain score were recorded 3 h,6 h,12 h,1 d,2 d and 3 d after surgery. The incidences of postoperative nausea and vomiting(PONV） was recorded 3 h,6 h,12 h,1 d,2 d and 3 d after surgery. The total propofol and remifentanil amounts of perioperative were recorded. The operating time of pectoral nerve block and intercostal nerve block were recorded. All block-related complications,such as hypotension,vascular puncture,or pneumothorax,were recorded. The duration of surgery and anesthesia were recorded. Results Compared with Group G,the total consumption of propofol and remifentanilamount significantly less than those in Group P and I,with significantly lower NRS scores 3 h,6 h,12 h,1 d,2 d and 3 d after surgery(P 〈0. 05）. Compared with Group G,the incidences of PONV 3 h,6 h and 12 h after surgery were significantly lower in group P and group I(P〈 0. 05）. The operating time of nerve block was significantly less in Group P than that in Group I(P 〈0. 05）. There was no significant difference in the consumption of propofol and remifentanil,the NRS score and the incidence of PONV between Group P and I(P〉 0. 05）. No block-related complication was reported in both two nerve block groups. Conclusion Both ultrasound-guided pectoral nerve block and intercostal nerve block are safe in breast cancer surgery can redu

关 键 词：胸壁神经阻滞 肋间神经阻滞 术后疼痛 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]