肋间神经阻滞麻醉在乳腺手术中的临床研究

Clinical Research of Intercostal Nerve Block Used in Operations of Mammary Gland

目的 :探讨肋间神经阻滞麻醉在乳腺手术中应用的镇痛效果和对呼吸循环的影响 ,及与高位硬膜外麻醉的比较。方法 :随机将患者分 3组 ,A、B组分别用罗哌卡因和布比卡因作为局麻药 ,取腋中线穿刺 ,选择阻滞 2支以上肋间神经 ,C组取T5-T6 间隙按硬膜外神经阻滞常规操作置管给药 ,记录镇痛效果及生命体征数据。结果 :3组患者麻醉效果均较满意 ,A、B组对血压、心率、呼吸影响甚微 ,C组麻醉前后出现有统计学意义的SBP、DBP、HR、R、SPO2 的下降 ,两例患者出现局麻药中毒反应经积极处理生命体征平稳。结论 :选择腋中线部位穿刺行肋间神经阻滞用于乳腺切除术取得较好的镇痛效果 ,对呼吸循环的影响较硬膜外麻醉小 ,安全性高 。

Objective:To observe the analgesic efficacy and effect of intercostal nerve block and epidural block on breath and circulation in mammary gland operations.Methods:Patients were divided into three groups randomly,in both Group A and Group B more than two intercostal nerves were blocked through midaxillary line;in Group A ropivacaine was used and in Group B bupivacaine was used.In Group C,routine epidural block was given in T5 6,record the analgesia effect and the Vital signs.Results:To all the patients the anaesthesia effect was satisfied,in Group A and B,the Vital signs were affected very lightly;in Group C the Vital signs dropped significantly,and there were two cases of intoxicaton of local anesthetic.Conclusion:In mammary gland operations it is easy to get a satified analgesia effect if intercostal nerve block through midaxillary line is taken,and it has less effect on breath and circulation comparied with epidural block.So,it is safe.Ropivacaine has less toxicity in intercostal nerve block comparied with bupivacaine.