应用自控静脉镇痛对乳腺癌改良根治术后患者恢复的影响
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摘要
目的探究自控静脉镇痛对乳腺癌患者行改良根治术后恢复的影响。方法选取行乳腺癌改良根治术的患者共87例,随机分为观察组(n=43)与对照组(n=44)。2组患者均在全麻状态下进行手术。观察组术后应用自控静脉镇痛,对照组无静脉镇痛。比较2组患者术后2 h、4 h、8 h、12 h、24 h、48 h的VAS评分与头晕、嗜睡、恶心呕吐、便秘、烦躁不安的发生情况。患者出院后,对其进行24个月的电话随访,统计随访期间2组患者的死亡人数与生存时间,采用Kaplan-Meier法和对数秩检验(log-rank test)进行生存分析。结果观察组患者的术后8 h、12 h、24 h、48 h的VAS评分显著低于对照组,差异具有统计学意义(P <0. 05);观察组术后头晕、嗜睡、恶心呕吐、便秘、烦躁不安及总不良反应发生率均显著低于对照组,差异具有统计学意义(P <0. 05)。生存分析结果表明,术后应用自控静脉镇痛可显著提高患者的生存率(P <0. 05)。结论术后应用自控静脉镇痛可减轻乳腺癌患者的术后疼痛及降低术后不良反应发生率,并改善患者预后,值得在临床推广使用。
Objective To explore the effect of patient-controlled intravenous analgesia on the recovery of breast cancer patients after modified radical mastectomy. Methods 87 patients with breast cancer undergoing modified radical mastectomy were randomly divided into the observation group( n = 43) and the control group( n = 44). The 2 groups were operated under general anesthesia. Patients in the observation group were given intravenous analgesia after operation,while the control group received no intravenous analgesia. The VAS scores at 2,4,8,12,24 and 48 hours after operation,and dizziness,lethargy,nausea,vomiting,constipation,fidgety were compared between the 2 groups. After discharged from hospital,the patients were followed up for 24 months. The number of deaths in the 2 groups during the follow-up period was counted. The survival analysis was performed by Kaplan-Meier method and log-rank test. Results The VAS scores of the observation group at 8,12,24 and 48 hours after operation were significantly lower than those of the control group( P < 0. 05). The incidence of dizziness,drowsiness,nausea,vomiting,constipation,restlessness and total adverse reactions were significantly reduced after operation( P < 0. 05). Survival analysis showed that postoperative patient-controlled intravenous analgesia can significantly improve the survival rate,and the difference were statistically significant( P < 0. 05). Conclusion Postoperative application of patient-controlled intravenous analgesia can reduce postoperative pain and incidence of adverse reactions in breast cancer patients,and improve the prognosis of patients,which is worthy of clinical application.
Objective To explore the effect of patient-controlled intravenous analgesia on the recovery of breast cancer patients after modified radical mastectomy. Methods 87 patients with breast cancer undergoing modified radical mastectomy were randomly divided into the observation group( n = 43) and the control group( n = 44). The 2 groups were operated under general anesthesia. Patients in the observation group were given intravenous analgesia after operation,while the control group received no intravenous analgesia. The VAS scores at 2,4,8,12,24 and 48 hours after operation,and dizziness,lethargy,nausea,vomiting,constipation,fidgety were compared between the 2 groups. After discharged from hospital,the patients were followed up for 24 months. The number of deaths in the 2 groups during the follow-up period was counted. The survival analysis was performed by Kaplan-Meier method and log-rank test. Results The VAS scores of the observation group at 8,12,24 and 48 hours after operation were significantly lower than those of the control group( P < 0. 05). The incidence of dizziness,drowsiness,nausea,vomiting,constipation,restlessness and total adverse reactions were significantly reduced after operation( P < 0. 05). Survival analysis showed that postoperative patient-controlled intravenous analgesia can significantly improve the survival rate,and the difference were statistically significant( P < 0. 05). Conclusion Postoperative application of patient-controlled intravenous analgesia can reduce postoperative pain and incidence of adverse reactions in breast cancer patients,and improve the prognosis of patients,which is worthy of clinical application.
引文
[1]刘苑欢,魏荣兴,邱群芳.联合检测CA15-3、CA125、CEA对乳腺癌临床诊断价值探讨〔J〕.实用癌症杂志,2014,29(4):406-408.
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[9]凌晨,胡旭东,张利国,等.乳腺癌根治术患者术后不同镇痛方式对细胞免疫功能及炎症介质的影响〔J〕.广东医学,2015,36(4):551-553.
[10]孙超,金薇.不同手术方式对乳腺癌患者预后及生存质量影响〔J〕.临床军医杂志,2018,46(8):892-893,896.
[11]方先海,张瑞芹.舒芬太尼及其术后自控静脉镇痛的应用〔J〕.中国临床康复,2006,10(2):153-155.
[12] Gul A,Ustundag H,Andsoy II,et al. Anxiety and pain in surgically treated breast cancer patients〔J〕. Asian Pac J Cancer Prev,2015,16(10):4261-4264.
[13]程明,方宏才,魏远江.乳腺癌术后腋下组织肌间静脉血栓形成机制及治疗研究〔J〕.现代医学,2016,44(10):1341-1344.
[14]汤涛.早期乳腺癌不同手术治疗方案的安全性、临床疗效及对患者生活质量的影响〔J〕.实用癌症杂志,2018,33(5):821-823,826.
[2]郑莹,吴春晓,张敏璐.乳腺癌在中国的流行状况和疾病特征〔J〕.中国癌症杂志,2013,23(8):561-569.
[3]中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2015版)〔J〕.中国癌症杂志,2015,25(9):692-754.
[4]陈德全,梁华娜,林晓妹.超声引导前锯肌阻滞对乳腺癌根治术患者术后急性疼痛和炎症反应的影响〔J〕.临床医学,2018,38(5):68-70.
[5]何自静,陈静,李密,等.盐酸羟考酮在乳腺癌改良根治手术后急性疼痛治疗中的应用〔J〕.临床麻醉学杂志,2016,32(3):255-257.
[6]陈敬锋,许礼旭,陈磊,等.舒芬太尼联合地佐辛对乳腺癌患者术后静脉自控镇痛的临床研究〔J〕.中国临床药理学杂志,2016,32(15):1387-1389+1399.
[7]安丽颖,陈园,王鹏.乳腺癌患者手术前后血清CA153、CA125及TSGF水平的变化及其意义〔J〕.实用癌症杂志,2018,33(4):550-552.
[8]冯海妹,戴茹萍.不同麻醉镇痛方法对乳腺癌根治术患者免疫功能与应激水平的影响〔J〕.现代医学,2017,45(2):194-199.
[9]凌晨,胡旭东,张利国,等.乳腺癌根治术患者术后不同镇痛方式对细胞免疫功能及炎症介质的影响〔J〕.广东医学,2015,36(4):551-553.
[10]孙超,金薇.不同手术方式对乳腺癌患者预后及生存质量影响〔J〕.临床军医杂志,2018,46(8):892-893,896.
[11]方先海,张瑞芹.舒芬太尼及其术后自控静脉镇痛的应用〔J〕.中国临床康复,2006,10(2):153-155.
[12] Gul A,Ustundag H,Andsoy II,et al. Anxiety and pain in surgically treated breast cancer patients〔J〕. Asian Pac J Cancer Prev,2015,16(10):4261-4264.
[13]程明,方宏才,魏远江.乳腺癌术后腋下组织肌间静脉血栓形成机制及治疗研究〔J〕.现代医学,2016,44(10):1341-1344.
[14]汤涛.早期乳腺癌不同手术治疗方案的安全性、临床疗效及对患者生活质量的影响〔J〕.实用癌症杂志,2018,33(5):821-823,826.