摘要
目的探讨超声引导竖脊肌间隙阻滞与胸椎椎旁神经阻滞治疗乳腺癌术后急性疼痛的有效性和安全性。方法研究纳入90例年龄在25~70岁准备择期行乳腺癌根治术患者。患者被随机分为竖脊肌阻滞(ESP)组,椎旁阻滞(PVB)组和对照组,每组30例。手术前根据分组给予超声引导竖脊肌间隙阻滞和胸椎椎旁神经阻滞,对照组不给于任何干预阻滞治疗。为所有患者提供静脉内患者自控镇痛装置。观察术后1、6、12和24 h吗啡使用剂量和视觉模拟疼痛评分(VAS)以及恶心呕吐的发生。结果吗啡消耗剂量:ESP组和对照组(P<0.001)之间以及PVB组和对照组之间差异有显著统计学意义(P<0.001),而ESP组和PVB组之间差异无统计学意义(P>0.05);VAS评分各组之间差异无统计学意义。对照组与ESP组和PVB组比较,恶心的发病率较高(P=0.008)。PVB组术后发现1例气胸。结论超声引导下ESP阻滞和PVB阻滞均可为接受乳腺癌手术的患者提供有效镇痛,并通过减少吗啡的使用剂量来降低患者恶心发生率。PVB阻滞有发生气胸的风险。
Objective To investigate the efficacy and safety of ultrasound-guided erector spinae block(ESP)and thoracic paravertebral block(PVB)in the treatment of acute pain after the surgery of breast cancer.Methods A total of 90 patients with breast cancer(aged 25-70 years),who were scheduled for elective radical mastectomy,were enrolled in this study.The patients were randomly and equally divided into ESP group,PVB group and control group,with 30 patients in each group.Before operation,ESP and PVB were performed for the patients of ESP group and PVB group respectively,while no intervention block treatment was given to the patients of the control group.Self-control intravenous analgesia device was provided for all patients.Each time at one,6,12,and 24 hours after surgery,the used dose of morphine,visual analog scale(VAS)score and the incidence of nausea and vomiting were recorded.Results Statistically significant difference in the used dose of morphine existed between ESP group and the control group(P<0.001)as well as between PVB group and the control group(P<0.001),while the difference in the used dose of morphine was not statistically significant between ESP group and PVB group(P>0.05).No statistically significant difference in VAS scores existed between each other among the three groups.The incidence of nausea in the control group was higher than that in the ESP group as well as in the PVB group(P=0.008).Postoperative pneumothorax occurred in one patient of PVB group.Conclusion The results of this study indicate that ultrasound-guided ESP and PVB can provide adequate analgesia for patients receiving radical mastectomy for breast cancer and reduce the incidence of nausea through the reduced use of morphine.PVB carries certain risk of pneumothorax.
作者
李晓
唐栋梁
王洁
单玉兰
LI Xiao;TANG Dongliang;WANG Jie;SHAN Yulan(Department of Anesthesia,Suzhou Municipal Ninth People’s Hospital,Suzhou,Jiangsu Province 215200,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第8期777-781,共5页
Journal of Interventional Radiology
关键词
超声引导
竖脊肌阻滞
胸椎椎旁神经阻滞
乳腺癌
疼痛
ultrasound guidance
erector spinae block
thoracic paravertebral nerve block
breast cancer
pain
