超声辅助连续胸椎旁神经阻滞联合全身麻醉用于乳腺癌根治术的麻醉及术后镇痛效果  

Ultrasound-assisted Continuous Thoracic Paravertebral Nerve Block Combined with General Anesthesia for the Anesthesia and Postoperative Analgesia of Radical Mastectomy of Breast Cancer

作　　者：王冬梅[1] 徐亮[1] 苗海敏[1] 李小玲 唐晓雷 WANG Dong-mei;XU Liang;MIAO Hai-min;LI Xiao-ling;TANG Xiao-lei(Department of Anesthesiology,Handan Hospital of Traditional Chinese Medicine,Handan,Hebei 056001,China)

机构地区：[1]邯郸市中医院麻醉科,河北邯郸056001

出　　处：《解放军医药杂志》2020年第3期117-120,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省医学科学研究重点课题计划项目(20191865)。

摘　　要：目的探讨超声辅助连续胸椎旁神经阻滞联合全身麻醉用于乳腺癌根治术的麻醉及术后镇痛效果。方法选择2015年1月—2019年3月接受乳腺癌根治术治疗的患者192例,根据麻醉方法分为干预组和对照组,每组96例。对照组采用全身麻醉,干预组采用超声辅助连续胸椎旁神经阻滞联合全身麻醉。观察2组术后4、8、12和24 h的Ramsay镇静评分以及在安静或咳嗽时的疼痛视觉模拟量表(VAS)评分,观察麻醉前(T1)、插管前(T2)、插管时(T3)、切皮时(T4)、拔管时(T5)的血压和心率变化。比较2组术后舒芬太尼和丙泊酚用量、清醒时间、不良反应及并发症发生情况。结果干预组术后各时间点安静和咳嗽时VAS评分低于对照组,而Ramsay镇静评分高于对照组(P<0.05)。干预组在T2~T5时间点的收缩压及心率变化优于对照组(P<0.05)。干预组术后舒芬太尼和丙泊酚用量少于对照组,清醒时间短于对照组,不良反应及并发症总发生率低于对照组(P<0.05)。结论超声辅助连续胸椎旁神经阻滞联合全身麻醉用于乳腺癌根治术的临床麻醉及术后镇痛效果显著,且不良反应发生率低。Objective To investigate the effect of ultrasound-assisted continuous thoracic paravertebral nerve block combined with general anesthesia for the anesthesia and postoperative analgesia during radical mastectomy for breast cancer.Methods A total of 192 patients who received radical mastectomy for breast cancer from January 2015 to March 2019 were selected,and were divided into the intervention group(n=96)and the control group(n=96)according to different anesthesia methods.The control group received general anesthesia,and the intervention group received ultrasound-assisted continuous thoracic paravertebral nerve block combined with general anesthesia.At 4,8,12 and 24 h after surgery,Ramsay sedation scores and visual analogue scale(VAS)scores for pain at rest or during coughing were observed in the two groups,and the changes of blood pressure and heart rate(HR)before anesthesia(T1),before intubation(T2),during intubation(T3),during skin incision(T4),and during extubation(T5)were observed.The dosage of sufentanil and propofol,wakening time,adverse reactions and complications were compared between the two groups.Results The VAS scores of the intervention group at rest or during coughing at different time points were lower than those of the control group,while the Ramsay sedation score was higher than that of the control group(P<0.05).The systolic blood pressure and HR of the intervention group were better than that of the control group at time points T2-T5(P<0.05).The postoperative dosage of Sufentanil and Propofol in the intervention group was less than that in the control group,the wakening time was shorter than that in the control group,and the overall incidence of adverse reactions and complications was lower than that in the control group(P<0.05).Conclusion Ultrasound-assisted continuous thoracic paravertebral nerve block combined with general anesthesia has a significant effect on clinical anesthesia and postoperative analgesia during radical mastectomy for breast cancer,with a low incidence of adverse reactions

关 键 词：乳腺肿瘤 连续胸椎旁神经阻滞 全身麻醉 右美托咪定 RAMSAY镇静评分 镇痛 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]