超声引导下肋间神经阻滞联合全麻对乳腺癌手术的麻醉效果及术后镇痛的影响

Effects of anesthesia and postoperative analgesia in ultrasound-guided intercostal nerve block combined with general anesthesia for breast cancer surgery

目的观察超声引导下肋间神经阻滞联合全麻对乳腺癌改良根治术麻醉效果及术后镇痛的影响。方法择期行乳腺癌改良根治术的患者60例,ASAⅠ~Ⅱ级,随机分为A组和B组,每组30例。A组全麻诱导前先行患侧超声引导下的肋间神经阻滞,B组直接行全麻诱导。术中根据BIS、血压及心率调节全麻药的泵注速度,手术结束时记录丙泊酚和瑞芬太尼的用量及全麻后患者的苏醒时间。患者的术后镇痛A组采用超声引导下的肋间神经阻滞,B组应用静脉泵术后镇痛,观察术后2 h、4 h、8 h、12 h、24 h的镇痛效果、镇静程度及术后并发症的情况。结果 A组与B组相比丙泊酚、瑞芬太尼的用量明显减少以及苏醒时间明显缩短,差异有统计学意义（P〈0.01或P〈0.05）。A组术后2、4 h的VAS评分与B组比较明显降低,差异有统计学意义（P〈0.05）,8 h、12 h、24 h的VAS评分相比差异无统计学意义（P〉0.05）。A组术后2 h、4 h、8 h、12 h、24 h的镇静评分与B组相比降低,差异有统计学意义（P〈0.05）。A组患者仅有2例发生恶心呕吐,未发生皮肤瘙痒、穿刺部位血肿、气胸等不良反应和并发症;B组有9例发生恶心呕吐,6例发生皮肤瘙痒,与A组发生率相比差异有统计学意义（P〈0.05）。结论超声引导下肋间神经阻滞可增强全麻的麻醉效果,减少麻醉药的用量,延长术后镇痛时效。

Objective To observe the analgesic effect, adverse reaction and the postoperative analgesic action of ultrasound-guided intercostal nerve block combined with general anesthesia and total intravenous anesthesia in modified radical mastectomy. Methods 40 patients undergoing elective modified radical mastectomy, ASA Ⅰ-Ⅱ grade, were randomly divided into group A and group B, 20 patients in each： general anesthesia ＋ ultrasound-guided intercostal nerve block group（group A）, total intravenous anesthesia group（group B）. According to BIS, blood pressure and heart rate regulate pumping speed anesthetics, group A took firstly ultrasound-guided intercostal nerve block before induction of anesthesia, group B took directly induction of general anesthesia. To record the entirely perioperative propofol and remifentanil drug amount as well as patient＇awake time after stopping anesthetics. Group A used ultrasound-guided intercostal nerve block and group B used intravenous pumps on postoperative analgesia, to observe postoperative analgesia and complications of 2, 4, 8, 12, 24 h. Results Propofol and remifentanil dosage of group A significantly reduced and the wake-up time was significantly shorter comparing with group B, and the difference was statistically significant（P〈0.01 or P〈0.05）. VAS scores of group A significantly reduced at postoperative 2 h and 4 h comparing with group B, the difference was statistically significant（P〈0.05）, there were no difference in VAS scores of 8 h, 12 h, 24 h（P〉0.05）. Sedation score of group A reduced at postoperative 2 h, 4 h, 8 h, 12 h and 24 h comparing with group B, the difference was statistically significant（P〈0.05）. The patients of group A with only two case of nausea and vomiting did not occur itchy skin, puncture site hematoma and pneumothorax; The patients of group B had nine cases of nausea and vomiting and six cases of skin itching, the difference was statistically significant comparing with the incidence of group A（P〈0.05）. Conclusion Ultrasound-guided intercostal nerve block anesthesia can enhance the effect of reducing the amount of anesthetic and prolong the duration of postoperative analgesia.