超声引导胸椎椎旁阻滞复合喉罩在单侧乳腺切除术中的应用体会

Ultrasound Guided Thoracic Paravertebral Block Combined with Laryngeal Mask in Unilateral Resection of Breast

目的探讨超声引导下胸椎椎旁神经阻滞复合喉罩在女性单侧乳腺区段切除术中的应用效果,为围术期寻找有效安全的方法。方法随机选取2015年1—12月该院120例需单侧乳腺区段切除手术患者,随机分为全凭静脉复合喉罩全麻组(A组)、胸段硬膜外阻滞复合喉罩全麻组(B组)、胸椎椎旁神经阻滞复合喉罩全麻组(C组),观察不同麻醉方式在单侧乳房切除术中的麻醉效果、术后镇痛,术后不良反应等方面的差异。结果 C组术中血流动力学更稳定[MAP(75.9±9.6)mm Hg、HR(72.2±4.8)次/min],明显优于A和B组(P<0.01);B组和C组术后镇痛明显优于A[术后2 h(2.3±1.4)分、术后4 h(4.8±1.0)分、术后6 h(7.3±1.5)分、术后12 h(8.0±1.3)分](P<0.01);C组术后的不良反应发生率(30.00%)明显少于A和B组(P<0.05)。结论超声引导胸椎椎旁神经阻滞复合喉罩全麻应用于单侧乳腺区段切除术,麻醉效果明显,术后镇痛好,安全性高。

Objective To investigate the ultrasound guided thoracic paravertebral nerve block combined with laryngeal mask resection in female unilateral breast section. Methods From Jannary 2015 to December 2015 120 cases for unilateral breast segment resection surgery patients were randomly divided into total intravenous LMA combined anesthesia group （group A）, thoracic epidural block combined with laryngeal mask general anesthesia group （group B） and thoracic paravertebral nerve block combined with laryngeal mask general anesthesia group （Group C）. Anesthetic effect and postoperative analgesia, postoperative adverse reactions and other aspects of the differences were observed by different methods of anesthesia. Re-sults The hemodynamics was more stable in C group[MAP（75.9±9.6）mmHg, HR（72.2±4.8） time/min], and B group was sig-nificantly higher than that of A （P﹤0.01）;B group and C group of postoperative analgesia was significantly higher than that of A[postoperation 2 h（2.3±1.4） score, postoperation 4 h（4.8±1.0） score, postoperation 6h（7.3±1.5） score, postoperation 12 h （8.0±1.3） score] （P﹤0.01）. Adverse reaction after operation in C group （30.00%） was less than that in A and B group （P﹤0.05）. Conclusion Ultrasound guided thoracic paravertebral nerve block combined with laryngeal mask anesthesia in unilat-eral segmental mastectomy had good postoperative analgesia effect and high safety.