乳腺癌改良根治术麻醉的优化策略:胸椎旁神经阻滞-无阿片药麻醉  

Optimization strategy for anesthesia in modified radical mastectomy for breast cancer:Paravertebral nerve block combined with opioid-free general anesthesia

作　　者：陈永智 张玉姣 史斌 王桂娟 李原 陈仁义 CHEN Yong-zhi;ZHANG Yu-jiao;Shi Bin;WANG Gui-juan;LI Yuan;CHEN Ren-yi(Department of Anesthesiology,Linyi Cancer Hospital,Linyi 276000,China;Department of General Surgery,Linyi Cancer Hospital,Linyi 276000,China)

机构地区：[1]山东省临沂市肿瘤医院麻醉科,山东临沂276000 [2]山东省临沂市肿瘤医院普外科,山东临沂276000

出　　处：《中国现代普通外科进展》2025年第2期114-118,共5页Chinese Journal of Current Advances in General Surgery

基　　金：山东省临沂市科技发展计划项目(2022YX0078)。

摘　　要：目的:评估无阿片药麻醉在乳腺癌改良根治术中的应用效果。方法:将80例择期行单侧乳腺癌改良根治术的患者随机分为两组:全麻组(G组)和无阿片药麻醉组(O组)。G组采用阿片类药物喉罩全麻,O组采用静脉注射利多卡因联合胸椎旁神经阻滞喉罩全麻。观测指标包括入室时(T_(0))、诱导时(T_(1))、手术开始时(T_(2))、腺体切除时(T_(3))、入复苏室时(T_(4))的平均动脉压(MAP)和心率(HR);手术时间、苏醒时间、排气时间和下床时间;术后2 h(T_(5))、6 h(T_(6))、12 h(T_(7))的VAS评分和术前(T_(8))、术后6 h(T_(9))、术后12 h(T_(10))的全身免疫炎症指数(SII);术后恶心呕吐(PONV)及乳腺癌术后疼痛综合征(PMPS)的发生情况;不良事件的发生情况等。结果:O组患者术中的MAP和HR较G组更平稳(P<0.05);O组苏醒时间、排气时间、下床时间均早于G组(P<0.05);术后VAS、SII数值均明显低于G组(P<0.05);PONV的发生率也显著降低(P<0.05);O组患者未发生气胸、血肿、局麻药中毒等不良事件。结论:无阿片药麻醉在乳腺癌改良根治术中安全有效,能够缩短苏醒时间、排气时间和下床时间,减轻术后疼痛和全身炎症反应,降低围术期循环波动,减少术后恶心呕吐的发生率。Objective:This study aimed to evaluate the application effect of opioid-free anesthesia(OFA)in modified radical mastectomy for breast cancer.Methods:80 patients undergoing unilateral modified radical mastectomy were randomly divided into two groups:general anesthesia group(G group)and OFA group(O group).The G group received general anesthesia with opioid drugs and a laryngeal mask,while the O group received general anesthesia with intravenous lidocaine combined with thoracic paravertebral nerve block and a laryngeal mask.The average arterial pressure(MAP)and heart rate(HR)of the patients were recorded at the time of admission(T_(0)),induction(T_(1)),start of surgery(T_(2)),gland resection(T_(3)),and admission to the recovery room(T_(4)).The surgical time,awakening time,extubation time,and getting out of bed time were recorded.The VAS score at 2 hours(T_(5)),6 hours(T_(6)),and 12 hours(T_(7))after surgery,as well as the systemic immune-inflammatory index(SII)before surgery(T_(8)),6 hours after surgery(T_(9)),and 12 hours after surgery(T_(10))were recorded.The occurrence of postoperative nausea and vomiting(PONV)and postmastectomy pain syndrome(PMPS)were recorded.The occurrence of adverse events such as poor nerve block effect,pneumothorax,hematoma,and local anesthetic toxicity were also recorded.Results:The MAP and HR of the O group were more stable than those of the G group during surgery(P<0.05).The awakening time,extubation time,and getting out of bed time in the O group were earlier than those in the G group(P<0.05).The VAS and SII values after surgery were significantly lower in the O group than in the G group(P<0.05).The incidence of PONV was also significantly decreased(P<0.05).In addition,no adverse events such as pneumothorax,hematoma,or local anesthetic toxicity occurred in the O group.Conclusion:Pioid-free anesthesia is safe and effective in modified radical mastectomy for breast cancer,shortening recovery time,time to first flatus,and time to ambulation,while alleviating postoperative pain,systemic inf

关 键 词：乳腺癌 椎旁神经阻滞 无阿片药麻醉 全身免疫炎症指数 

分 类 号：R737.9[医药卫生—肿瘤]