右美托咪定复合罗哌卡因Ⅱ型胸部神经阻滞对乳腺癌改良根治术后快速康复的影响  

Effect of dexmedetomidine in combined with ropivacaine for pectoral nerve blockⅡon enhanced recovery after modified radical mastectomy

作　　者：刘伟伟[1] 徐伟[1] 夏瑞[1] Liu Weiwei;Xu Wei;Xia Rui(Department of Anesthesiology,The First Affiliated Hospital of Yangtze University(the First People's Hospital of Jingzhou),Jingzhou 434000,China)

机构地区：[1]长江大学附属第一医院荆州市第一人民医院麻醉科,荆州434000

出　　处：《北京医学》2020年第2期129-131,135,共4页Beijing Medical Journal

摘　　要：目的研究右美托咪定(dexmedetomidine,Dex)复合罗哌卡因Ⅱ型胸部神经阻滞(pectoral nerve blockⅡ,PECSⅡ)对乳腺癌改良根治术后快速康复的影响。方法选取2019年1~5月长江大学附属第一医院首次行单侧乳腺癌改良根治术的患者102例,随机分为生理盐水组(C组)、罗哌卡因组(R组)、Dex复合罗哌卡因组(RD组),每组34例。全麻诱导后行PECSⅡ,C组注入生理盐水30 ml,R组注入0.375%罗哌卡因30 ml,RD组注入0.375%罗哌卡因复合1μg/kg Dex共30 ml。记录术中丙泊酚和瑞芬太尼用量、术后镇痛药用量、手术结束至患者出现疼痛的时间(无痛时间)、疼痛数字分级评分(numerical rating scale,NRS)、术后48 h疼痛评分最高值(NRSmax)、术后恶心呕吐发生率、麻醉后恢复室(postanesthesia care unit,PACU)停留时间、肠排气时间和术后住院时间。结果相比C组和R组,RD组无痛时间明显延长,差异有统计学意义(P<0.05),术后恶心呕吐发生率降低(P<0.05),肠排气时间缩短(P<0.05)。相较于C组,R组和RD组围术期麻醉药用量减少,即刻NRS和NRSmax降低,PACU停留时间和住院时间缩短。3组均无严重心动过缓和低血压等不良反应。结论Dex复合罗哌卡因PECSⅡ能为乳腺癌改良根治术的患者提供更长的术后无痛时间,减少术后相关并发症的发生率,有利于患者快速康复。Objective To investigate the effect of dexmedetomidine in combined with ropivacaine for pectoral nerve blockⅡ(PECSⅡ)on enhanced recovery after surgery in patients undergoing modified radical mastectomy.Methods One hundred and two patients for modified radical mastectomy,were randomly divided into three groups,34 cases in each group using a random table:normal saline group(group C),ropivacaine group(group R),dexmedetomidine combined with ropivacaine group(group RD).After general anesthesia,patients in group C received PECSⅡwith normal saline 30 ml,group R received PECSⅡwith 0.375%ropivacaine 30 ml,group RD received PECSⅡwith 0.375%ropivacain and dexmedetomidine1μg/kg in 30 ml.The dosages of propofol and remifentanil during operation,painless time(the time from the end of operation to the beginning of pain),immediate pain score,the max pain score during 48 hours post-operation,administration of supplemental analgesia and adverse events were recorded.Results Compared with group C and R,patients in group RD had longer painless time[(890.6±214.6)min,P<0.05],less incidence of postoperative nausea and vomiting(6%,P<0.05)and shorter carminative time[(4.3±1.5)h,P<0.05].Compared with group C,patients in group R and group RD had less consumption of anesthetic perioperatively,shorter PACU stay time and hospital stay,lower immediate pain score and lower max pain score during 48 hours post-operation.There was no serious hypotension or bradycardia in all groups.Conclusions Dexmedetomidine as an adjuvant in PECSⅡcan provide longer analgesic time,better analgesic effect and enhanced recovery after surgery for patients undergoing modified radical mastectomy.

关 键 词：右美托咪定 罗哌卡因 胸部神经阻滞 乳腺癌改良根治术 术后快速康复 

分 类 号：R737.9[医药卫生—肿瘤] R614[医药卫生—临床医学]