摘要
目的 :探讨全麻联合胸椎旁阻滞应用于乳癌改良根治手术术后镇痛效果及抗炎作用。方法 :于2016年1月～2017年6月,选择在我院择期拟全麻下行乳癌改良根治术(MRM)的病人48例,将其随机分均为2组,A组为全身麻醉组(TIVA组),B组为全麻联合胸椎旁阻滞组(TIVA+TPVB组),每组24例患者,B组通过超声辅助于T4间隙行胸椎旁神经阻滞,然后两组患者以相同的方法再进行喉罩通气全身麻醉。观察指标:术后第1h、4h、8h、16h及24 h的评估视觉模拟量表(VAS)疼痛评估;测定麻醉前、手术开始0.5h、手术结束和术后8h的血清中TNF-a,IL-6及IL-10的水平;术后不良反应。结果 :术后第1h,4h和8h的VAS评分B组显著低于A组;炎性因子方面,两组患者在手术结束时及术后第8h血清中TNF-a,IL-6及IL-10的水平明显高于麻醉前;B组患者血清中TNF-a,IL-6的水平显著低于A组,而IL-10的水平则显著高于A组;B组术后麻醉相关不良反应的例数少于A组但两组无统计学差异。结论 :全麻联合胸椎旁阻滞应用到乳癌改良根治术术后镇痛效果提高同时并没有增加麻醉相关的不良反应,并且有效地减少炎性因子的分泌,因此全麻联合胸椎旁阻滞对促进行MRM患者术后快速恢复有重要价值及意义。
Objective To investigate the effect of general anesthesia combined with thoracic paravertebral block in breast modified radical surgery postoperative analgesia and anti-inflammatory effect. Methods In January o hospital undergoing general anesthesia after modified radical mastectomy of breast cancer(MRM)2 i0 n1 6-2017 year in June, in urrandomly divided into 48 cases of patients were 2 groups were group A, general anesthesia group(group TIVA, group B) for general anesthesia combined with thoracic paravertebral block group(TIVA+TPVB group), 24 patients in each group, group B by ultrasound assisted T4 clearance for thoracic paravertebral block, then the two groups of patients with the same method of general anesthesia. Observation index: After 1 h, 4 h, 8 h, 16 h and evaluation of 24 h visual analogue scale(VAS) were measured before anesthesia, pain assessment;operation 0.5 h, TNF-a the end of surgery and postoperative serum 8 h, IL-6 and IL-10 levels;adverse reaction after operation. Results The postoperative 1 H score, VAS B group 4 H and 8 h were significantly lower than A group;inflammatory factors in the patients of the two groups at the end of surgery and postoperative 8 h in serum TNF-a, IL-e anesthesia;B group in the serum of patients with TN F-a, the level of 6 and IL-IL-10 levels were significantly higher than those beforp;the number of cas6 was significantly lower than that of A group, while the IL-10 level was significantly higher than that of A groues of adverse reactions in group B after anesthesia than in the A group but no significant difference between two groups. Conclusion General anesthesia combined with paravertebral block applied to breast modified radical postoperative analgesia effect is improved at the same time did not increase anesthesia related adverse reactions, and effectively reduce the secretion of inflammatory factors, so the combined general thoracic paravertebralblock for MRM patients to promote rapid recovery after has important value and significance.
作者
杨岗
刘忠玉
李刚
杨娜
Yang Gang;Liu Zhong-yu;Li Gang;Yang Na(Department of Qinhuangdao Maternal and Child Health Care Hospital, Qinhuangdao 066000, China)
出处
《湖南师范大学学报（医学版）》
2018年第6期126-129,共4页
Journal of Hunan Normal University(Medical Sciences)
关键词
全身麻醉
胸椎旁阻滞
术后镇痛
炎性因子
乳癌改良根治术
general anesthesia
thoracic paravertebral block
postoperative analgesia
inflammatory factors
modified radical mastectomy
