乳腺癌改良根治术患者近端肋间臂神经联合前锯肌平面阻滞临床效果观察  

Clinical effect of proximal intercostobrachial nerve combined with serratus anterior plane block in patients undergoing modified radical mastectomy for breast cancer

作　　者：姚溪[1] 侯敏娜[1] 岳芳 郭姣[1] YAO Xi;HOU Minna;YUE Fang;GUO Jiao(Department of Anesthesiology,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院麻醉科,陕西西安710068

出　　处：《陕西医学杂志》2024年第9期1228-1231,1235,共5页Shaanxi Medical Journal

基　　金：陕西省科技计划项目(2021JQ-918)。

摘　　要：目的:探讨乳腺癌改良根治术患者近端肋间臂神经阻滞联合前锯肌平面阻滞(SAPB)的临床效果。方法:选择在全身麻醉下行乳腺癌改良根治术的患者60例,采用随机数字表法分为近端肋间臂神经阻滞联合SAPB组(联合组)和SAPB组(前锯肌组),每组30例。两组分别在全麻诱导后行超声引导下近端肋间臂神经阻滞联合前锯肌平面阻滞和前锯肌平面阻滞。采用视觉模拟评分法(VAS)记录患者术后30 min及2、4、8、24 h疼痛情况。记录术中瑞芬太尼使用总量、术后24 h舒芬太尼使用总量、补救镇痛时间、24 h内补救镇痛率以及不良反应情况。结果:与前锯肌组比较,联合组术后2、8 h的VAS评分降低,术中瑞芬太尼的使用量及术后舒芬太尼的使用量减少,总不良反应率降低,首次补救镇痛时间延长,24 h内补救镇痛率降低(均P<0.05)。结论:与前锯肌平面阻滞相比,近端肋间臂神经阻滞联合前锯肌平面阻滞可以减少围手术期阿片类药物使用,改善乳腺癌改良根治术患者术后镇痛效果。Objective:To investigate the clinical effect of proximal intercostobrachial nerve block combined with serratus anterior plane block(SAPB)in patients undergoing modified radical mastectomy for breast cancer.Methods:Sixty patients undergoing modified radical mastectomy for breast cancer under general anesthesia were randomly divided into proximal intercostulobrachial nerve block combined with SAPB group(combined group)and SAPB group(serratus anterior group),with 30 patients in each group.After induction of general anesthesia,the two groups underwent ultrasound-guided proximal intercostabrachial nerve block combined with serratus anterior plane block and serratus anterior plane block,respectively.VAS was used to record the pain at 30 min,2,4,8 and 24 hours after operation.The total amount of remifentanil used during operation,the total amount of sufentanil used within 24 hours after operation,the time of rescue analgesia,the rate of rescue analgesia within 24 hours,and adverse reactions were recorded.Results:Compared with the serratus anterior group,the VAS scores at 2,8 hours after operation were significantly decreased,the consumption of intraoperative remifentanil and postoperative sufentanil were decreased,the total adverse reaction rate was decreased,the first rescue analgesia time was prolonged,and the rescue analgesia rate within 24 hours was decreased in the combined group(all P<0.05).Conclusion:Compared with serratus anterior plane block,proximal intercostaobrachial nerve block combined with serratus anterior plane block can reduce perioperative opioid use and improve postoperative analgesia in patients undergoing modified radical mastectomy for breast cancer.

关 键 词：乳腺癌改良根治术 近端肋间臂神经阻滞 前锯肌平面阻滞 术后疼痛 超声引导 阿片类药物 

分 类 号：R614.4[医药卫生—麻醉学]