摘要
背景与目的:许多患者在单纯全麻下行乳腺癌改良根治术后会出现急性疼痛。该研究旨在探讨全麻复合肋间神经阻滞是否可减轻乳腺癌改良根治术后急性疼痛的程度。方法:选择择期行乳腺癌改良根治术的患者96例,使用随机数字表法随机分为单纯全麻组(G组)和全麻复合肋间神经阻滞组(C组)。G组直接行全身麻醉;C组则在麻醉诱导前在超声辅助下经腋中线入路行肋间神经阻滞,当神经阻滞起效后再行全身麻醉。两组患者全麻诱导用药相同,当术中血压或心率大于基础值20%时追加舒芬太尼10μg。苏醒期追加舒芬太尼直至VAS评分为0。记录术中及术后舒芬太尼用量和患者术后2(T1)、12(T2)和24 h(T3)静息时痛觉VAS评分以及术后2和24 h恶心、呕吐的发生率。结果:两组患者在年龄、体质量指数、手术时间等方面差异无统计学意义。术中及术后C组患者舒芬太尼用量分别为(25.2±3.5)和(3.3±1.2)μg,G组分别为(40.5±4.3)和(8.4±2.2)μg,两组比较,C组均明显少于G组,差异有统计学意义(P<0.01);T1、T2和T3各时点C组患者VAS评分分别为(0.45±0.15)、(1.75±0.08)和(2.05±0.12)分,G组患者VAS评分分别为(4.32±0.21)、(4.88±0.13)和(4.78±0.16)分,两组比较,C组均明显低于G组,差异有统计学意义(P<0.01);术后2和24 h各时点C组恶心、呕吐发生率分别为6.25%和16.66%,G组分别为20.8%和41.66%,两组比较,C组均明显低于G组,差异有统计学意义(P<0.01)。C组患者无1例出现肋间神经阻滞并发症。结论:与单纯全麻相比,全麻复合肋间神经阻滞可显著减少术中及术后阿片类药物用量,减轻乳腺癌改良根治术患者术后急性疼痛的程度,降低术后恶心、呕吐的发生率。超声辅助下进行肋间神经阻滞可提高操作的安全性和准确性,提高患者的满意度。
Background and purpose： Many patients may suffer from acute pain after radical mastectomy under general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anesthesia on analgesia after radical rnastectorny for breast cancer. Methods： Ninety-six patients underwent modified radical mastectomy for breast cancer were randomized with random number into group C （intercostal nerve block coupled with general anesthesia） and group G （general anesthesia）, with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general anesthesia was the same between the two groups. During the surgery, 10μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 （T1）, 12 （T2） and 24 h （T3） after surgery. The incidence of postoperative nausea and vomiting was also observed. Results： Sufentanil amount used intra- and post- operation were significantly lower in group C [（25.2±3.5） and （3.3±1.2）μg] than that in group G [（40.5±4.3） and （8.4±2.2） μg] （P 〈 0.01）. The VAS scores on 2, 12 and 24 h after surgery in group C（0.45±0.15, 1.75±0.08and 2.05±0.12）, were significantly lower than those in group G （4.32±0.21, 4.88±0.13 and 4.78±0.16） （P〈0.01）. The incidences of nausea and vomiting on 2 and 24 h after surgery in group C （6.25% and 16.66%） were significantly lower than those in group G （20.8% and 41.66%）. There was no adverse complication related with intercostal nerve block in group C. Conclusion： Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modified radical mastectomy for breast cancer, which may improve post
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2015年第7期544-548,共5页
China Oncology
基金
国家自然科学基金资助项目(N5FC81471852)
上海市自然科学基金资助项目(KW1307)
关键词
肋间神经阻滞
联合麻醉
术后镇痛
恶心
呕吐
Intercostal nerve block
Combined anesthesia
Postoperative analgesia
Nausea and vomiting
