超声引导下胸前壁神经阻滞对乳腺癌根治术患者超前镇痛的疗效研究  

Ultrasound-guided pectoral nerves block for preemptive analgesia in patients undergoing radical mastectomy

作　　者：方毅琦 方建胜 魏凌云 李城女 Fang Yiqi;Fang Jiansheng;Wei Lingyun;Li Chengnü(Department of Anesthesiology,Chun'an County First People's Hospital,Hangzhou 311700,China)

机构地区：[1]杭州市淳安县第一人民医院麻醉科

出　　处：《北京医学》2019年第12期1086-1088,1093,共4页Beijing Medical Journal

基　　金：杭州市卫生计生科技计划(2018B073)

摘　　要：目的评价超声引导下胸前壁神经(pectoral nerves, PECS)阻滞用于乳腺癌根治术超前镇痛对患者快速康复的有效性及安全性。方法选择2017年1月至2018年12月淳安县第一人民医院择期行单侧乳腺癌根治术女性患者48例,年龄≤60岁,ASA分级Ⅰ~Ⅱ级。按随机区组法分为超声引导下胸前壁神经阻滞治疗组(P组)和空白对照组(C组),每组24例。全身麻醉诱导后,P组在超声引导下实施胸前壁神经阻滞并给予0.25%罗哌卡因15 ml后行喉罩全身麻醉;C组不给予胸前壁神经阻滞行喉罩全身麻醉。两组术后均采用电子自控镇痛泵。记录患者术后4 h、8 h、12 h、24 h和48 h静息状态下的VAS评分,术中镇静、镇痛药物用量及追加的镇静药物量、术后苏醒和拔管时间以及术后不良反应发生情况。结果术后4 h、8 h、12 h、24 h和48 h的VAS评分P组(0.75、1.58、2.00、1.92、1.92)明显低于C组(3.83、3.83、3.75、3.17、2.67),差异有统计学意义(P <0.001);芬太尼在麻醉诱导、术中追加以及总量的使用上P组明显少于C组(P <0.01);P组术后平均拔管时间(5.75 min)明显早于C组(16.50 min,P <0.001);P组无呕吐发生,C组有2例,差异无统计学意义(P> 0.05)。结论超声引导下胸前壁神经阻滞可以安全有效地应用于乳腺癌根治术超前镇痛,提供良好的术后镇痛效果且安全可靠。Objective To evaluate the efficacy and safety of ultrasound-guided pectoral nerves(PECS) block for preemptive analgesia in patients undergoing radical mastectomy for breast cancer. Methods Forty-eight female patients with unilateral radical mastectomy, aged less than 60 years, in ASAⅠ-Ⅱ, were enrolled. According to the randomized block method,the patients were divided into two groups: the treatment group(group P) and the blank control group(group C), 24 cases in each group. Group P underwent pectoral nerves block under ultrasound guidance and received laryngeal mask general anesthesia after giving 0.25% ropivacaine 15 ml. Group C received laryngeal mask general anesthesia without pectoral nerves block.Both groups were treated with electronic controlled analgesia pump after operation. The VAS score of pain was recorded immediately after recovery(0 hours after operation), 4, 8, 12, 24, 48 hours after operation in resting state. And the dosage of sedative and analgesic drugs during operation, the time of recovery and extubation after operation, and the occurrence of adverse reactions after operation were recorded. Results The VAS scores of group P(average scores were 0.75, 1.58, 2.00, 1.92 and1.92) were significantly lower than those of group C(average scores were 3.83, 3.83, 3.75, 3.17 and 2.67, respectively) at 4, 8,12, 24 and 48 hours after operation(P<0.001). The use of fentanyl in anesthesia induction, intraoperative supplementation and total amount in group P were significantly less than those in group C. The average extubation time of group P(5.75 minutes) was significantly faster than that of group C(16.50 minutes, P<0.001). There were two cases of vomiting in group C and no adverse reactions in group P. There was no significant difference in the incidence of vomiting between the two groups(P>0.05). Conclusions Ultrasound-guided pectoral nerves nerve block can be safely and effectively applied to preemptive analgesia in radical mastectomy. It can provide good postoperative analgesic effect, and it is saf

关 键 词：超声引导 胸前壁神经阻滞 超前镇痛 乳腺癌手术 

分 类 号：R61[医药卫生—外科学]