摘要
目的:观察肋间神经阻滞复合全身麻醉用于乳腺癌改良根治手术的临床效果及对其术后镇痛的影响。方法:选择择期行乳腺癌改良根治手术的患者60例,ASAⅠ-Ⅱ级,随机分为A、B两组,A组为实验组(30例),即肋间神经阻滞复合全身麻醉组。B组为对照组(30例),即单纯全身麻醉组。观察两组患者术中及术后不良反应发生率、术中麻醉药物用量、术后镇痛药物的用量、术后镇痛效果(VAS评分和患者满意度评分)。结果:B组患者术中心动过速及高血压发病率大于A组(P<0.05),术后恶心呕吐发病率大于A组(P<0.05)。B组术中瑞芬太尼的用量大于A组(P<0.01),术后24h内舒芬太尼的使用量多于A组(P<0.01)。A组患者在术后1h、4h、8h和12h的VAS评分低于B组(P<0.05),患者满意度高于B组(P<0.05),两组VAS评分在18h、24h差异无统计学意义。A组患者术后住院天数少于B组患者,术后第二周生活质量评分高于B组患者(P<0.05)。结论:肋间神经阻滞复合全身麻醉用于乳腺癌改良根治术可明显减少阿片类药物的使用量,减少术中及术后不良反应发生率,提高术后镇痛的效果及患者的满意度,同时可促进患者术后康复。
Objective: To observe the effects of intercostal nerve block combined with general anesthesia for modified radical mastectomy. Methods: A total of 60 women who were classified as Ⅰ- Ⅱ grade in ASA classification were randomly divided into two groups. Patients in group A( 30 cases) accepted intercostal nerve block combined with general anesthesia. Patients in group B( 30 cases) accepted general anesthesia only. The total dose of general anesthetics during operation,HR and MAP changes during the stage of analepsia,pain visual analog scores( VAS) after surgery,patient's satisfaction score and side- effects intraoperative and postoperative were evaluated. Results: The incidence of tachycardia and hypertension was higher in group B( P〈0. 05). The incidence rate of nausea,vomiting in group B was higher than group A( P〈0. 05). The use amount of remifentanly was greater in group B( P〈0. 01). The use amount of sufentanly in group B was significantly greater than in group A within 24 hours after surgery( P〈0. 01). The VAS in 1h,4h,8h and 12 h was significantly lower in group A than in group B( P〈0. 0 1). The satisfaction score in 1 h,4 h,8 h and 1 2 h was significantly higher in group A than in group B( P〈0. 01). The hospitalization days after surgery was less in group A than group B,and the ADL was higher in group A( P〈0. 05). Conclusion: Intercostal nerve block combined with general anesthesia used for modified radical mastectomy can significantly reduce the dose of analgesics used in the operation,reduce the incidence of side- effects,and significantly improve the effect of postoperative analgesia,moreover,can improve the recovery of patients after surgery.
出处
《现代肿瘤医学》
CAS
2016年第18期2971-2975,共5页
Journal of Modern Oncology
关键词
肋间神经阻滞
乳腺癌改良根治术
术后镇痛
术后康复
intercostal nerve block
modified radical mastectomy
analgesia
recovery after surgery