摘要
目的观察超声引导下Ⅱ型胸神经(PECSⅡ)阻滞用于乳腺癌手术镇痛时右美托咪定强化罗哌卡因的效果.方法将行择期乳腺癌手术患者100例随机分为观察组和对照组,每组各50例.两组均在麻醉诱导前行术侧超声引导下PECSⅡ阻滞.对照组选择0.25%罗哌卡因,观察组选择同等剂量、浓度的罗哌卡因并加入1μg/kg右美托咪定.观察并比较两组手术时间,术中瑞芬太尼用量,术后3 h、6 h、12 h、24 h数字评分量表评分(NRS),术后恶心、呕吐(PONV)发生率、麻醉复苏室(PACU)停留时间、术后24 h内患者静脉自控镇痛(PCIA)舒芬太尼用量和患者满意度情况.结果两组手术时间比较,差异无统计学意义(t=1.39,P>0.05),观察组患者术中瑞芬太尼用量少于对照组,差异有统计学意义(t=11.16,P<0.05).观察组术后3 h、6 h、12 h NRS评分均低于对照组(t分别=8.42、10.43、9.86,P均<0.05),在术后24 h NRS评分比较,差异无统计学意义(t=1.39,P>0.05).观察组术后满意度明显高于对照组,PONV发生率低于对照组,术后24 h PCIA舒芬太尼用量明显少于对照组,PACU停留时间短于对照组,差异均有统计学意义(χ2分别=13.66、7.29,t分别=32.54、5.31,P均<0.05).结论超声引导下PECSⅡ阻滞用于乳腺癌手术镇痛,右美托咪定联合罗哌卡因比单纯应用罗哌卡因可以明显地改善麻醉与镇痛效果,减少围术期阿片类药物的用量,减少不良反应的发生,提高患者满意度.
Objective To observe the analgesia effect of dexmedetomidine combined with ropivacaine for ultrasoundguided PECSⅡ block in breast cancer surgery. Methods Totally 100 patients who underwent breast cancer surgery were randomly divided into observation group and control group,50 cases in each. All patients received ultrasound-guided PECSⅡblock before induction of anesthesia. 0.25% ropivacaine was used in the control group,and 1μg/kg dexmedetomidine was used in the observation group on the basis of the control group.The operation time,intraoperative remifentanil dosage,postoperative NRS scores at the 3 h,6 h,12 h and 24 h,nausea and vomiting incidence,PACU residence time,PCIA sufentanil dosage within 24 hours after surgery and patients’ satisfaction between two groups were compared. Results The difference in operation time between two groups was not statistically significant(t=1.39,P>0.05),the dosage of remifentanil of the observation group was less than that of the control group(t=11.16,P<0.05).Postoperative NRS scores at 3 h,6 h,12 h of the observation group were lower than those of the control group,and the differences were statistically significant(t=8.42,10.43,9.86,P<0.05),while the NRS score at 24 h between two groups was not significantly different(t=1.39,P>0.05).Compared to the control group,the patients’ satisfaction of the observation group was higher,the incidence of nausea and vomiting was lower as well as PCIA sufentanil dosage within 24 hours after operation,and the residence time in PACU of the observation group was shorter(χ2=13.66,7.29,t=32.54,5.31,P<0.05). Conclusion Dexmedetomidine combined with ropivacaine can significantly improve the effect of analgesia on ultrasound-guided PECSⅡblock in breast cancer surgery patients,reduce the dosage of opioids used during perioperative period and the incidence of adverse reactions,and improve patient satisfaction.
作者
敖慧芳
刘静
黄新华
AO Huifang;LIU Jing;HUANG Xinhua(Huzhou Maternity and Child Care Hospital,Huzhou 313000,China)
出处
《全科医学临床与教育》
2019年第11期1001-1004,共4页
Clinical Education of General Practice
