胸椎旁神经阻滞麻醉生理干扰在乳腺癌改良根治术中的应用效果  

Application Effect of Thoracic Paravertebral Nerve Block Anesthesia and Physiological Interference in Modified Radical Mastectomy of Breast Cancer

作　　者：程永冲 孙佳 邓姗 李欣洁 肖海峰 马光兵 Cheng Yongchong;Sun Jia;Deng Shan;Li Xinjie;Xiao Haifeng;Ma Guangbing(Department of Anesthesiology,No.987 Hospital,Joint Logistics Support Force,Baoji,Shaanxi Province,721000 China)

机构地区：[1]联勤保障部队第九八七医院麻醉科,陕西宝鸡721000

出　　处：《系统医学》2022年第7期21-25,共5页Systems Medicine

摘　　要：目的探讨胸椎旁神经阻滞麻醉(TPVB)生理干扰在乳腺癌改良根治术中的应用效果。方法选取2019年1月—2021年6月收治的乳腺癌患者80例,随机分为两组,各40例,对照组采用全身麻醉,观察组采用全麻诱导前行TPVB,比较两组麻醉药物应用情况、疼痛与镇静程度、血流动力学、应激指标及不良反应。结果观察组舒芬太尼用量(48.72±8.92)μg、丙泊酚用量(432.92±97.83)mg低于对照组,静脉自控镇痛按压次数(9.69±2.58)次少于对照组(5.83±1.34)次,差异有统计学意义(t=9.357、3.051、8.397,P<0.001)。观察组4、8、12、24 h VAS评分(1.72±1.14)分、(1.48±0.69)分、(1.53±0.57)分、(1.33±0.73)分低于对照组;Ramsay镇静评分(2.47±0.59)分、(2.85±1.21)分、(2.54±0.76)分、(2.48±0.64)分高于对照组,差异有统计学意义(t=7.046、6.137、4.775、3.761、5.660、5.199、4.613、3.996,P<0.001)。观察组插管、切皮、腋窝清扫、拔管、出室时HR(75.29±5.27)、(79.55±6.83)、(76.26±5.28)、(75.52±6.93)、(78.57±6.25)次/min低于对照组;观察组插管、切皮、腋窝清扫、拔管、出室时MAP低于对照组;观察组切皮、腋窝清扫时BIS(44.26±5.35)、(48.23±4.85)低于对照组,差异有统计学意义(t=2.513、5.269、7.636,P<0.001)。观察组术后24 h肾上腺素(7.86±1.47)nmol/L、去甲肾上腺素(11.49±2.18)nmol/L低于对照组,差异有统计学意义(t=10.145、6.335,P<0.001)。观察组不良反应发生率(15.00%)低于对照组(42.50%),差异有统计学意义(χ^(2)=7.384,P=0.007)。结论TPVB应用于乳腺癌手术患者能够提高麻醉效果,改善血流动力学,降低术后应激,减少不良反应。Objective To investigate the effect of physiological interference of thoracic paravertebral block anesthesia(TPVB)in modified radical mastectomy for breast cancer.Methods A total of 80 breast cancer patients admitted from January 2019 to June 2021 were selected and randomly divided into two groups with 40 cases in each group.The control group was given general anesthesia,the observation group was induced TPVB before general anesthesia.The application of anesthetics,the degree of pain and sedation,hemodynamics,stress indicators and adverse reactions were compared between the two groups.Results The dosage of sufentanil(48.72±8.92)μg and the dosage of propofol(432.92±97.83)mg in the observation group were lower than those in the control group,and the number of compressions for patient-controlled intravenous analgesia(9.69±2.58)times was less than that in the control group(5.83±1.34)times,the difference was statistically significant(t=9.357,3.051,8.397,P<0.001).The VAS scores(1.72±1.14) points, (1.48±0.69) points, (1.53±0.57) points, (1.33±0.73) points of the observation group were lower than the control group;the Ramsay sedation scores (2.47±0.59) points, (2.85±1.21) points, (2.54±0.76) points, (2.48±0.64) points of the observation group were higher than the control group, the difference was statistically significant (t=7.046, 6.137, 4.775, 3.761, 5.660, 5.199, 4.613, 3.996, P<0.001). The HR in the observation group during intubation, skin incision, axillary dissection, extubation, and discharge from the chamber (75.29±5.27)times/min, (79.55±6.83)times/min, (76.26±5.28)times/min, (75.52±6.93)times/min, (78.57±6.25)times/min was lower than that of the control group;the MAP of the observation group was lower than that of the control group at the time of intubation, skin incision, axillary dissection, extubation, and discharge from the chamber;the BIS (44.26±5.35), (48.23±4.85) of the observation group was lower than that of the control group during skin incision and axillary dissection, the differe

关 键 词：胸椎旁神经阻滞 乳腺癌 应激 血流动力学 

分 类 号：R59[医药卫生—内科学]