经皮穴位电刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术的麻醉效果

Anesthesia effect of thoracic paravertebral nerve block guided by ultrasound and percutaneous acupoint electrical stimulation for breast cancer radical surgery

目的研究经皮穴位点刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术的麻醉效果。方法选取2021年1月-2022年1月唐山市协和医院收治的120例行乳腺癌改良根治术患者为研究对象,根据麻醉方式的不同分为对照组和观察组,每组60例。对照组患者术前行单纯超声引导下胸椎旁神经阻滞,观察组患者术前行经皮穴位电刺激辅助出超声引导下胸椎旁神经阻滞,比较两组患者入室时(T-0)、麻醉时(T_(1))、插管时(T_(2))、切皮时(T_(3))、腋窝清扫时(T_(4))、拔管时(T_(5))、出室时(T-6)的心率(Heart rate,HR)和平均动脉压(Mean arterial pressure,MAP)和脑电双频指数(Bispectral index,BIS)血流动力学指标,术中舒芬太尼和丙泊酚用量,术后镇痛泵按压次数,术后不同时间点疼痛视觉模拟评分、不良反应发生情况。结果与对照组比较,观察组T_(3)、T_(4)时刻HR降低,T_(2)、T_(3)、T_(4)、T_(5)时刻BIS指数降低;术中舒芬太尼和丙泊酚用量、术后镇痛泵按压次数均降低;术后2、4、8、12、24 h VAS评分均降低,术后不良反应发生率降低,差异均有统计学意义(P<0.05)。结论经皮穴位电刺激辅助超声引导下胸椎旁神经阻滞用于乳腺癌根治术可提升麻醉效果,缓解患者疼痛,安全性良好,促进患者术后转归。

Objective To explore the anesthetic effect of paravertebral nerve block guided by ultrasound and percutaneous acupoint electrical stimulation for breast cancer radical surgery.Methods 120 patients with breast cancer who underwent modified radical mastectomy in the hospital from January 2021 to January 2022 were selected as the research objects,and the patients were divided into the control group and the observation group according to the different surgical methods,with 60 cases in each group.Before the operation,the patients in the control group were subjected to thoracic paravertebral nerve block under the guidance of ultrasound alone.Before the operation,the patients in the observation group were subjected to thoracic paravertebral nerve block under the guidance of ultrasound assisted by percutaneous electrical stimulation of acupoints.The hemodynamic indexes at different times,the amount of sufentanil and propofol used during the operation,the number of times of pressing the analgesic pump after the operation,the visual analog score of pain at different time points after the operation,and the occurrence of adverse reactions were compared.Results Compared with the control group,the observation group showed the decreasing in HR at T_(3)and T_(4),and the decreasing in BIS index at T_(2),T_(3),T_(4),and T_(5).The dosage of sufentanil and propofol during the surgery,as well as the number of postoperative analgesia pump presses,were decreased.The VAS scores were decreased at 2,4,8,12,and 24 hours after the surgery,and the incidence of postoperative adverse reactions were decreased,with statistical significance(P<0.05).Conclusion Acupoint stimulation assisted with ultrasound guided thoracic paravertebral nerve block for breast cancer radical surgery can improve the anesthetic effect,relieve patients′pain,have good safety,and it can promote the patients′postoperative outcomes.