连续胸椎旁神经阻滞在乳腺癌全麻手术中的效果观察
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摘要
目的探讨全麻复合连续胸椎旁神经阻滞在乳腺癌手术中的麻醉及术后镇痛效果。方法选取手术治疗乳腺癌患者86例,随机分为2组各43例。对照组行全麻复合静脉自控镇痛,观察组行全麻复合连续胸椎旁神经阻滞。记录2组不同时段血流动力学变化情况,麻醉药用量、疼痛评分及术后恢复情况。结果麻醉诱导前2组心率、平均动脉压水平差异无统计学意义(P<0.05),切皮后5 min和术毕观察组心率和平均动脉压水平均低于对照组,差异有统计学意义(P<0.05);观察组丙泊酚(623.17±87.54) mg、舒芬太尼(45.26±6.74)μg用量少于对照组[(772.54±97.63) mg,(53.28±9.02)μg],清醒时间及拔管时间短于对照组,且术后不同时段疼痛视觉模拟评分均低于对照组,不良反应发生率6.98%(3/43)低于对照组23.26%(10/43),差异有统计学意义(P<0.05)。结论全麻复合连续胸椎旁神经阻滞可有效提高乳腺癌手术麻醉及镇痛效果,有利于维持患者围手术期血流动力学稳定,且术后不良反应发生率低,安全有效。
Objective To investigate the effect of anesthesia and postoperative analgesia of general anesthesia combined with continuous thoracic paravertebral nerve block(CTPVB) in breast cancer surgery.Methods Eighty-six patients with breast cancer surgery were selected and grouped according to the random number table method,with 43 cases in each group.The control group underwent general anesthesia combined with intravenous analgesia,and the observation group underwent general anesthesia combined with CTPVB.The changes of heart rate(HR) and mean arterial pressure(MAP) in two different time periods(before anest hesia induction),T1(5 min after incision),T2(completed surgery) were recorded.The doses of propofol and sufentanil were compared between the two groups.The postoperative awake,extubation time,postoperative pain(VAS) scores and the incidence of adverse reactions at 24 h after surgery.Results There was no significant difference in HR and MAP between the two groups before anesthesia induction(P<0.05).The HR and MAP in the observation group were lower than those in the control group at 5 min after the incision.The difference was statistically significant(P<0.05);the amount of propofol(623.17±87.54 mg) and sufentanil(45.26±6.74) μg in the observation group was less than that in the control group(772.54±97.63) mg,(53.28±9.02) μg,awake time and extubation The time was shorter than that of the control group,and the visual analogue scale of pain was lower than that of the control group at different time points.The incidence of adverse reactions was 6.98%(3/43),whichwas lower than that of the control group 23.26%(10/43).The difference was statistically significant(P<0.05).Conclusion General anesthesia combined with continuous thoracic paravertebral nerve block can significantly improve the anesthesia and analgesic effect in breast cancer surgery,This method is beneficial to maintain the perioperative hemodynamic stability,and the incidence of postoperative adverse reactions is low,safe and effective.
Objective To investigate the effect of anesthesia and postoperative analgesia of general anesthesia combined with continuous thoracic paravertebral nerve block(CTPVB) in breast cancer surgery.Methods Eighty-six patients with breast cancer surgery were selected and grouped according to the random number table method,with 43 cases in each group.The control group underwent general anesthesia combined with intravenous analgesia,and the observation group underwent general anesthesia combined with CTPVB.The changes of heart rate(HR) and mean arterial pressure(MAP) in two different time periods(before anest hesia induction),T1(5 min after incision),T2(completed surgery) were recorded.The doses of propofol and sufentanil were compared between the two groups.The postoperative awake,extubation time,postoperative pain(VAS) scores and the incidence of adverse reactions at 24 h after surgery.Results There was no significant difference in HR and MAP between the two groups before anesthesia induction(P<0.05).The HR and MAP in the observation group were lower than those in the control group at 5 min after the incision.The difference was statistically significant(P<0.05);the amount of propofol(623.17±87.54 mg) and sufentanil(45.26±6.74) μg in the observation group was less than that in the control group(772.54±97.63) mg,(53.28±9.02) μg,awake time and extubation The time was shorter than that of the control group,and the visual analogue scale of pain was lower than that of the control group at different time points.The incidence of adverse reactions was 6.98%(3/43),whichwas lower than that of the control group 23.26%(10/43).The difference was statistically significant(P<0.05).Conclusion General anesthesia combined with continuous thoracic paravertebral nerve block can significantly improve the anesthesia and analgesic effect in breast cancer surgery,This method is beneficial to maintain the perioperative hemodynamic stability,and the incidence of postoperative adverse reactions is low,safe and effective.
引文
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[2] UESHIMA H,OTAKE H.Thoracic paravertebral nerve block for treating contraction of the latissimus dorsi muscle after breast cancer surgery[J].J Clin Anesth,2018,50:69.
[3] PIPANMEKAPORN T,SAETENG S.The use of continuous thoracic paravertebral nerve block under direct vision for postoperative pain management in thoracic surgery [J].J Med Assoc Thai,2012,95(2):191-197.
[4] OGUZ S,Kü?üK C,ESKI?IRAK E,et al.Thoracic paravertebral block for breast surgery in a patient with myasthenia gravis[J].J Anesth,2007,21(3):449.
[5] 干超,汪云飞,陈红梅.全麻复合胸椎管旁神经阻滞与单纯全麻在胸科手术中的比较[J].中医学报,2014,29(B07):460.
[6] 巩红岩,段文姣,刘景景,等.超声引导连续胸椎旁神经阻滞复合右美托咪定麻醉对食管癌手术患者围术期应激反应的影响[J].新乡医学院学报,2016,33(4):291-296.
[7] 陈孝平,汪建平.外科学[M].8版.北京:人民卫生出版社,2013:256-260.
[8] ABDEL-HALIM J M K.Continuous thoracic paravertebral block:An adjunct to general anaesthesia in major breast surgery[J].Egypti J Anaesth,2011,27(2):87.
[9] KULHARI S,BHARTI N,BALA I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesiaafter radical mastectomy:a randomized controlled trial [J].Br J Anaesth,2016,117(3):382-386.
[10] SOPENAZUBIRIA L A,FERNáNDEZMERé LA,VALDéS ARIAS C,et al.Thoracic paravertebral block compared to thoracic paravertebral block plus pectoral nerve block in reconstructive breast surgery[J].Rev Esp Anestesiol Reanim,2012,59(1):12-17.
[11] 汲振荣,唐冰,裴凌.超声引导下椎旁神经阻滞在开胸手术及术后镇痛中的应用[J].中国医师进修杂志,2016,39(2):168-171.
[12] IBARRA M M,S-CARRALERO G C,VICENTE G U,et al.Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery[J].Rev Esp Anestesiol Reanim,2011,58(5):290-294.
[13] KAMIYA Y,HASEGAWA M,YOSHIDA T,et al.Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery:A randomised controlled trial[J].Eur J Anaesthesiol,2017,35(3):1.
[14] 田文华,高嵩,杨帆,等.右美托咪定复合罗哌卡因对乳腺手术患者行胸椎旁神经阻滞麻醉效果的影响[J].中国医院药学杂志,2015,35(24):2 224-2 227.
[15] 孙立新,王彬,王明山,等.全身麻醉复合双侧胸椎旁神经阻滞在非体外循环冠脉搭桥术的应用[J].临床麻醉学杂志,2014,30(3):213-216.
[16] 张留福,米卫东,张艳峰.乳腺手术患者胸椎旁神经阻滞与全身麻醉效果比较的Meta分析[J].临床麻醉学杂志,2014,30(12):1 214-1 217.
[17] JADON A.Nerve stimulator-guided thoracic paravertebral block for gynecomastia surgery[J].Indian J Anaesth,2012,56(3):298-300.
[17] BOEZAART A P,RAW R M.Continuous Thoracic Paravertebral Block for Major Breast Surgery[J].Reg Anesth Pain Med,2006,31(5):470-476.
[19] EL-BOGHDADLY K,MADJDPOUR C,CHIN K J.Thoracic paravertebral blocks in abdominal surgery-A systematic review of randomized controlled trials[J].Br J Anaesth,2016,117(3):297-308.
[20] 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,2015,25(7):544-548.
[21] ELDEEN T,HALA M S.Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast:A randomized controlled trial[J].Egypti J Anaesth,2016,32(1):29-35.
[22] ASIDA S M,YOUSSEF I A,MOHAMAD A K,et al.Post-thoracotomy pain relief:Thoracic paravertebral block compared with systemic opioids[J].Egypti J Anaesth,2012,28(1):60.
[23] DIZDAREVIC A,FERNANDES A.Thoracic Paravertebral Block,Multimodal Analgesia,and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis[J].Case Rep Anesthesiol,2016:6 301 358.
[24] Ní EOCHAGáIN A,BURNS D,RIEDEL B,et al.The effect of anaesthetic technique during primary breast cancer surgery on neutrophil-lymphocyte ratio,platelet-lymphocyte ratio and return to intended oncological therapy[J].Anaesthesia,2018,73(5):603-611.DOI:10.1111/anae.14207.
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