硬膜外复合全麻在乳腺癌切除同期乳房再造的镇痛效果分析  

Analysis of analgesic effect of combined epidural anesthesia in breast cancer resection and breast reconstruction

作　　者：梁杰 秦廷臣 LIANG Jie;QIN Yan-chen(Department of Anesthesiology,Jiaozuo Second People's Hospital,Henan Province,454000,China)

机构地区：[1]焦作市第二人民医院麻醉科,河南焦作454000

出　　处：《中国医疗美容》2021年第1期46-49,共4页China Medical Cosmetology

摘　　要：目的分析硬膜外复合全麻在乳腺癌切除同期乳房再造的镇痛效果。方法选择2018年1月~2020年6月行乳腺癌切除术同期乳房再造的患者作为研究对象。其中采用硬膜外复合全麻28例纳入观察组,单纯全身麻醉者40例纳入对照组。比较不同时间点平均动脉压、心率;术后2h、6h、24h、48h的疼痛视觉模糊评分,48h内PCIA按压次数;皮瓣相关并发症及麻醉相关并发症。结果T0时两组MAP、HR比较差异无统计学意义(P>0.05)。T1-4时观察组MAP、HR均低于对照组,差异有统计学意义(P<0.05)。两组患者术后2hVAS评分比较差异无统计学意义。术后6h、24h、48hVAS评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后48h内PCIA按压(1.68±1.08)次,低于对照组(2.75±1.46)次,差异有统计学意义(P<0.05)。观察组发生皮瓣危象2例,对照组发生皮瓣危象4例,两组比较差异无统计学意义(P>0.05)。观察组发生恶心3例,呕吐2例,少于对照组(恶心15例,呕吐12例),差异有统计学意义(P>0.05)。结论硬膜外复合全麻在乳腺癌切除同期乳房再造中生命体征稳定,且可提高术后镇痛效果,降低术后麻醉相关不良反应。Objective To analyze the analgesic effect of combined epidural anesthesia in breast cancer resection and breast reconstruction.Methods From January 2018 to June 2020,patients who underwent breast cancer resection and breast reconstruction at the same time were selected as the research objects.Among them,28 cases of epidural general anesthesia were included in the observation group,and 40 cases of simple general anesthesia were included in the control group.The mean arterial pressure(map)and heart rate(HR)at different time points were compared;the visual blur score of pain at 2 h,6 h,24 h and 48 h after operation;the number of PCIA presses within 48 h;flap related complications and anesthesia related complications were compared.Results There was no significant difference in map and HR between the two groups at t0(P>0.05).At T1-4,map and HR in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in VAS score between the two groups.The VAS scores at 6 h,24 h and 48 h after operation were lower than those in the control group(P<0.05).In the observation group,PCIA was pressed(1.68±1.08)times within 48 hours after operation,which was lower than(2.75±1.46)times in the control group,and the difference was statistically significant(P<0.05).There were 2 cases of skin flap crisis in the observation group and 4 cases in the control group.There was no significant difference between the two groups(P>0.05).There were3 cases of nausea and 2 cases of vomiting in the observation group,which were less than those in the control group(15 cases of nausea and 12 cases of vomiting),and the difference was statistically significant(P>0.05).Conclusion Epidural general anesthesia in breast cancer resection and breast reconstruction has stable vital signs,can improve postoperative analgesia effect and reduce postoperative anesthesia related adverse reactions.

关 键 词：乳腺癌切除联合乳房再造术 硬膜外阻滞麻醉 静脉麻醉 术后镇痛 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]