经导管3个水平胸椎旁阻滞预防乳腺癌术后疼痛综合征的疗效观察  

Paravertebral catheter for three-level injection in radical mastectomy and its effects on post-mastectomy pain syndrome

作　　者：陈利[1] 孙彩霞[1] CHEN Li;SUN Cai-xia(Department of Anesthesiology,the Affiliated Hospital of Jiangsu University,Zhenjiang Jiangsu 212001,China)

机构地区：[1]江苏大学附属医院麻醉科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2018年第1期56-60,64,共6页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:探讨经导管3个水平胸椎旁阻滞用于乳腺癌改良根治术患者的应用价值。方法:将40例择期行乳腺癌改良根治术患者随机分为全麻组和椎旁阻滞组(阻滞组),全麻组行经喉罩全身麻醉,阻滞组在喉罩全麻基础上联合经导管3个水平胸椎旁阻滞。记录患者离开苏醒室时、术后4 h、术后8 h、术后12 h 4个围术期急性疼痛观察时点和术后3月、术后6月两个慢性疼痛观察时点的VAS评分;比较两组术中舒芬太尼的用量、手术结束至苏醒室内清醒后拔管的时间,术后24 h的恶心、呕吐发生率;术后3月、6月时的疼痛部位和1周内的疼痛发生天数及简式Mc Gill(SF-MPQ)问卷得分。结果:(1)急性疼痛评分比较:除术后4 h运动和术后8 h静息时与全麻组无显著差异外(P>0.05),阻滞组在其余急性期观察点VAS评分均明显低于全麻组(均P<0.05);(2)与全麻组比较,阻滞组术中舒芬太尼用量显著减少、清醒拔管时间明显缩短(均P<0.05),但恶心、呕吐发生率无显著差异(P>0.05);(3)慢性疼痛评分比较:阻滞组VAS评分除术后3月静息时与全麻组无差异外,术后3月运动时和术后6月静息、运动时均显著低于全麻组(均P<0.05);(4)乳腺癌根治术术后疼痛综合征(PMPS)发生率:两组患者在3月、6月时的PMPS发生率无显著差异(P>0.05);(5)SF-MPQ得分:阻滞组SF-MPQ评分在术后3月、6月时均明显低于全麻组(P<0.05);(6)急、慢性疼痛观察点运动VAS评分的相关性:全麻组各急性疼痛观察时点与3月、6月时VAS评分均有相关性(P<0.05);阻滞组除术后4 h、术后8 h与6月时VAS评分无相关性外(P>0.05),其他急性疼痛观察时点与3月、6月时VAS评分均有相关性(P<0.05)。结论:经导管3个水平胸椎旁阻滞联合喉罩全身麻醉用于乳腺癌改良根治术,不仅可显著改善术后急性疼痛,减少手术中舒芬太尼用量,缩短患者术毕拔管时间,还可显著降低PMPS患者疼痛评分,提高患者术后生To evaluate the value of paravertebral catheter for three-level injection via catheter using in modified radical mastectomy.Methods:A total of40patients were randomly divided into paravertebral block group(TPVB)and general anesthesia group(GA).TPVB group received paravertebral block via catheter and injections at three different levels combined with general anesthesia,while GA group using standard laryngeal mask general anesthesia.Acute and chronic pain VAS were recorded at the following observation points both at rest and movement,including discharging form postanesthesia care unit(PACU),4h,8h,12h(acute pain),3months and6months(chronic pain)after surgery.The amount of sufentanil during operation,the time of extubation and the incidence of nausea and vomiting at24h was also recorded.At3months and6months,the pain site,pain frequency and short-form McGill pain questionnaire(SF-MPQ)were recorded.Results:①Postoperative acute pain VAS:There was no significant difference at4h on movement and8h at rest after surgery between two groups(P>0.05),although TPVB group s VAS were significantly lower than that of the GA group in the rest of acute pain observation points(P<0.05);②Compared with the GA group,TPVB group s sufentanil dosage,extubation time were reduced or shortened(P<0.05),but there was no significant difference in the incidence of nausea and vomiting at24h after surgery(P>0.05);③Chronic pain VAS:Pain VAS at rest has no difference between two groups at3months after surgery(P>0.05),and VAS of TPVB group was statistically lower than that of the GA group at3months and6months other observation points(P<0.05);④post-mastectomy pain syndrome(PMPS)incidence:There was no significant difference in the incidence of PMPS between the two groups at3and6months(P>0.05);⑤SF-MPQ:The score in TPVB group was statistically lower than that in GA group both at3and6months(P<0.05);⑥Correlation about chronic pain VAS:TPVB group:there was correlation between all acute pain and chronic pain VAS(P<0.05),but4h and8h s was not correla

关 键 词：乳癌术后疼痛综合征 胸椎旁阻滞 慢性疼痛 乳腺癌改良根治术 

分 类 号：R614.42[医药卫生—麻醉学]