罗库溴铵麻醉诱导在乳腺癌改良根治术患者中的应用研究及安全性分析
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摘要
目的:探讨罗库溴铵麻醉诱导在乳腺癌改良根治术患者中的应用效果及安全性。方法:选取我院2015年7月—2017年8月收治的87例乳腺癌患者,均行乳腺癌改良根治术,按照随机数字表法分成两组,对照组(43例)采用顺式阿曲库铵(0.1 mg/kg)进行麻醉诱导,观察组(44例)采用罗库溴铵(0.8 mg/kg)进行麻醉诱导,观察比较两组麻醉起效时间、麻醉持续时间及诱导前15 min(T0)、诱导后(T1)、喉罩插入后3 min(T2)去甲肾上腺素(NE)、肾上腺素(E)水平变化情况,并统计两组术后不同时间点(术后3 h、6 h、12 h)疼痛程度[视觉模拟评分法(VAS)]评分及不良反应发生情况。结果:观察组麻醉起效时间短于对照组,麻醉持续时间长于对照组,差异有统计学意义(P <0.05);两组T0时刻NE及E水平比较,差异无统计学意义(P> 0.05),T1及T2时刻观察组NE、E水平低于对照组,差异有统计学意义(P <0.05);术后3 h、6 h及12 h观察组VAS评分低于对照组,差异有统计学意义(P <0.05);观察组不良反应发生率为6.82%,低于对照组的23.26%,差异有统计学意义(P <0.05)。结论:罗库溴铵麻醉诱导可减轻乳腺癌改良根治术患者术后疼痛程度,麻醉起效时间短,对应激反应影响小,不良反应少。
Objective: To explore the application effect and safety of rocuronium bromide anesthesia induction in patients undergoing modified radical mastectomy for breast cancer. Methods: 87 patients with breast cancer undergoing modi?ed radical mastectomy admitted to our hospital from July 2015 to August 2017 were selected and randomly divided into two groups. The patients in the control group(43 cases) were treated with cis-atracurium(0.1 mg/kg) for anesthesia induction, and the patients in the observation group(44 cases)were treated with rocuronium bromide(0.8 mg/kg) for anesthesia induction. The onset time and duration of anesthesia and changes in the levels of norepinephrine(NE) and epinephrine(E) 15 minutes before induction(T0), after induction(T1) and 3 minutes after laryngeal mask insertion(T2) were observed and compared between the two groups. The scores of pain degree(visual analogue scale, VAS) at different time points after operation(3 h, 6 h, 12 h after operation) and adverse reactions were statistically analyzed. Results: The onset time of anesthesia in the observation group was shorter than that in the control group, and the duration of anesthesia was longer than that in the control group, with statistically significant differences(P<0.05). There were no statistically signi?cant differences in NE and E levels between the two groups at T0(P>0.05). The levels of NE and E at T1 and T2 in the observation group were lower than those in the control group, with statistically signi?cant differences(P<0.05). The scores of VAS 3 h, 6 h and 12 h after operation in the observation groupwere lower than those in the control group, with statistically significant differences(P<0.05). The incidence of adverse reactions in the observation group was 6.82%, which was lower than 23.26% in the control group, and the difference was statistically significant(P<0.05). Conclusion: Rocuronium bromide anesthesia induction can alleviate postoperative pain degree in patients undergoing modified radical mastectomy for breast cancer, and has short anesthesia onset time, small effect on stress response and few adverse reactions.
Objective: To explore the application effect and safety of rocuronium bromide anesthesia induction in patients undergoing modified radical mastectomy for breast cancer. Methods: 87 patients with breast cancer undergoing modi?ed radical mastectomy admitted to our hospital from July 2015 to August 2017 were selected and randomly divided into two groups. The patients in the control group(43 cases) were treated with cis-atracurium(0.1 mg/kg) for anesthesia induction, and the patients in the observation group(44 cases)were treated with rocuronium bromide(0.8 mg/kg) for anesthesia induction. The onset time and duration of anesthesia and changes in the levels of norepinephrine(NE) and epinephrine(E) 15 minutes before induction(T0), after induction(T1) and 3 minutes after laryngeal mask insertion(T2) were observed and compared between the two groups. The scores of pain degree(visual analogue scale, VAS) at different time points after operation(3 h, 6 h, 12 h after operation) and adverse reactions were statistically analyzed. Results: The onset time of anesthesia in the observation group was shorter than that in the control group, and the duration of anesthesia was longer than that in the control group, with statistically significant differences(P<0.05). There were no statistically signi?cant differences in NE and E levels between the two groups at T0(P>0.05). The levels of NE and E at T1 and T2 in the observation group were lower than those in the control group, with statistically signi?cant differences(P<0.05). The scores of VAS 3 h, 6 h and 12 h after operation in the observation groupwere lower than those in the control group, with statistically significant differences(P<0.05). The incidence of adverse reactions in the observation group was 6.82%, which was lower than 23.26% in the control group, and the difference was statistically significant(P<0.05). Conclusion: Rocuronium bromide anesthesia induction can alleviate postoperative pain degree in patients undergoing modified radical mastectomy for breast cancer, and has short anesthesia onset time, small effect on stress response and few adverse reactions.
引文
[1]Moran MS,Schnitt SJ,Giuliano AE,et al.Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer[J].Int J Radiat Oncol Biol Phys,2014,88(3):553-564.
[2]王建英.喉罩全麻方案应用于乳腺癌改良根治术麻醉效果及不良反应评价[J].浙江创伤外科,2015,20(5):1045-1046.
[3]王芸,缪长虹,许平波.全麻复合肋间神经阻滞对乳腺癌改良根治术后镇痛效果的影响[J].中国癌症杂志,201525(7):544-548.
[4]张秋莹,李立明,胡同江.两种肌肉松弛药对骨科手术患者麻醉诱导期应激反应的影响[J].医药论坛杂志,201738(3):159-161.
[5]郑育秀,徐志新,黄泽波,等.不同肌松药对乳腺癌患者麻醉诱导期应激反应的影响[J].西南国防医药,201626(11):1262-1265.
[6]陈孝平,汪建平.外科学(第8版)[M].北京:人民卫生出版社,2013:256-260.
[7]Kersten P,White PJ,Tennant A.Is the pain visual analogue scale linear and responsive to change?An exploration using Rasch analysis[J].Plos One,2014,9(6):e99485.
[8]樊肖冲,马民玉,弓胜凯,等.全麻手术不同时限七氟醚对罗库溴铵肌松效应的研究[J].中华实验外科杂志,201532(6):1398-1400.
[2]王建英.喉罩全麻方案应用于乳腺癌改良根治术麻醉效果及不良反应评价[J].浙江创伤外科,2015,20(5):1045-1046.
[3]王芸,缪长虹,许平波.全麻复合肋间神经阻滞对乳腺癌改良根治术后镇痛效果的影响[J].中国癌症杂志,201525(7):544-548.
[4]张秋莹,李立明,胡同江.两种肌肉松弛药对骨科手术患者麻醉诱导期应激反应的影响[J].医药论坛杂志,201738(3):159-161.
[5]郑育秀,徐志新,黄泽波,等.不同肌松药对乳腺癌患者麻醉诱导期应激反应的影响[J].西南国防医药,201626(11):1262-1265.
[6]陈孝平,汪建平.外科学(第8版)[M].北京:人民卫生出版社,2013:256-260.
[7]Kersten P,White PJ,Tennant A.Is the pain visual analogue scale linear and responsive to change?An exploration using Rasch analysis[J].Plos One,2014,9(6):e99485.
[8]樊肖冲,马民玉,弓胜凯,等.全麻手术不同时限七氟醚对罗库溴铵肌松效应的研究[J].中华实验外科杂志,201532(6):1398-1400.