连续胸椎旁神经阻滞对乳腺癌术后疼痛综合征的影响  

EFFECT OF CONTINUOUS THORACIC PARAVERTEBRAL BLOCK ON POST-MASTECTOMY PAIN SYNDROME AFTER RADICAL MASTECTOMY

作　　者：靳红绪[1] 张同军[1] 孙学飞[1] 张华[1] 王福朝[1] 吕东海[1] 姚长青[1] 王忠义[1] JIN Hong-Xu;ZHANG Tong-Jun;SUN Xue-Fei;ZHANG Hua;WANG Fu-Chao;LV Dong-Hai;YAO Chang-Qing;WANG Zhong-Yi(Deparment of Anesthesiology,Harrison International Peace Hospital,Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北省衡水市哈励逊国际和平医院麻醉科

出　　处：《中国疼痛医学杂志》2019年第9期671-675,共5页Chinese Journal of Pain Medicine

基　　金：河北省医学科学研究重点课题计划(ZD20140266)

摘　　要：目的:探讨超声引导下连续胸椎旁神经阻滞对乳腺癌术后疼痛综合征(post-mastectomy pain syndrome,PMPS)的影响。方法:择期行单侧乳腺癌根治术病人206例,年龄32~76岁,体质量指数(body mass index,BMI)17.3~34.5 kg/m2,美国麻醉医师协会分级I或II级,采用随机数字表法,将其随机均分为两组:连续胸椎旁神经阻滞联合全麻组(PG组)和单纯全麻组(GA组)。PG组病人于全麻诱导前在超声引导下行手术侧胸3椎旁间隙注射0.5%的罗哌卡因20 ml并置入导管。两组病人诱导后插入喉罩丙泊酚全凭静脉维持麻醉,术后PG组给予连续胸椎旁神经自控镇痛(patient controlled thoracic paravertebral analgesia,PCPA),GA组给予自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。记录术中芬太尼和丙泊酚的用量、术后48 h镇痛泵有效按压次数、补救镇痛例数、镇痛满意率情况和不良反应。随访术后3、6、12个月时病人PMPS的发生情况。结果:与GA组相比,PG组术中丙泊酚用量和芬太尼用量明显减少(P<0.05);PG组术后48 h内镇痛泵有效按压次数、补救镇痛例数均显著少于GA组,术后镇痛满意率显著高于GA组(P<0.05);PG组病人术后嗜睡、PONV及尿潴留等不良反应率较GA组显著下降(P<0.05)。PG组病人术后3、6、12个月PMPS的发生率明显低于GA组(P<0.05)。结论:超声引导下连续胸椎旁神经阻滞镇痛用于乳腺癌根治术病人效果确切,不良反应发生少,可有效减少PMPS的发生率。Objective:To investigate the effect of ultrasound-guided continuous thoracic paravertebral block on post-mastectomy pain syndrome(PMPS)in patients undergoing radical mastectomy.Methods:Two hundred and six patients scheduled for radical mastectomy,aged 32-76 yrs,body mass index(BMI)17.3-34.5 kg/m2,American society of anesthesiologists physical status I or II,were randomly divided into 2 groups using a random number table method:continuous thoracic paravertebral nerve block combined with general anesthesia group(PG)and simple general anesthesia group(GA).Before induction of anesthesia,patients in group PG were injected with 0.5%ropivacaine for 20 ml and placed into the catheter in the cavity of the thoracic paravertebral under ultrasound guidance.Patients of two groups were inserted laryngeal mask after anesthesia induction,and propofol was administered by intravenous anesthesia.The patients received continuous patient controlled thoracic paravertebral analgesia(patient controlled thoracic paravertebral analgesia,PCPA)in group PG after operation,while patients in group GA received patient controlled intravenous analgesia(patient controlled intravenous analgesia,PCIA).The consumption of fentanyl and propofol during operation,the times of effective delivered doses 48 h after operation,the cases of remedial analgesia,the satisfaction rate of analgesia and the adverse reactions were recorded.The incidence of PMPS were evaluated follow-up in 3,6 and 12 months after the operation.Results:Compared with group GA,the intraoperative dosage of fentanyl and propofol were significantly less than that in group GA(P<0.05).The number of effective analgesia pump pressing within 48 h after operation,the remedial analgesic cases and the adverse reaction rate in group PG were significantly less than that in group GA(P<0.05),and satisfaction rate of analgesia in group PG was higher(P<0.05).The incidence of PMPS in postoperative 3,6 and 12 months were significantly lower than that in group GA(P<0.05).Conclusion:Ultrasound-guided continu

关 键 词：连续胸椎旁神经阻滞 乳腺癌术后疼痛综合征 超声引导 

分 类 号：R61[医药卫生—外科学]