术后不同镇痛方式在单侧乳腺癌根治术患者中的应用

Application of different postoperative analgesia methods in unilateral breast cancer radical surgery

目的比较不同镇痛方式在单侧乳腺癌根治术患者术后镇痛中的应用效果,为乳腺癌根治术患者选择合适的术后镇痛模式。方法选择择期在全麻下行单侧乳腺癌根治术女性患者90例,年龄35~60岁,体重45~80kg,ASAⅠ或Ⅱ级,随机分成单纯静脉镇痛组(P组)、局部浸润+静脉镇痛组(R组)和超声引导下胸椎旁神经阻滞+静脉镇痛(TP组),每组30例。P组:右美托咪定2μg/kg+舒芬太尼2μg/kg;R组:0.375%罗哌卡因20ml局部浸润+右美托咪定2μg/kg+舒芬太尼2μg/kg;TP组:0.375%罗哌卡因20ml椎旁阻滞+右美托咪定2μg/kg+舒芬太尼2μg/kg。记录三组术后6、12、24、48hVAS评分和Ramsay评分;记录术前、术后24、48h深睡眠质量评分;记录术后24h内镇痛泵按压次数、舒芬太尼使用总量以及恶心、呕吐、瘙痒、心动过缓、呼吸抑制等不良反应的发生情况。结果术后6hR组和TP组VAS评分明显低于P组,术后12hTP组VAS评分明显低于R组和P组(P<0.05);三组术后不同时点Ramsay评分差异无统计学意义。术后24hTP组深睡眠质量评分明显低于P组和R组(P<0.05);术后24h内TP组镇痛泵按压次数和舒芬太尼使用总量明显少于R组和P组,R组镇痛泵按压次数和舒芬太尼使用总量明显少于P组(P<0.05);三组术后24h内恶心、呕吐、瘙痒、心动过缓、呼吸抑制差异均无统计学意义;TP组未发生超声引导下椎旁神经阻滞相关并发症。结论三种术后镇痛方式均可安全有效地用于单侧乳腺癌根治术患者的术后镇痛,且超声引导下胸椎旁神经阻滞联合自控静脉镇痛方式的镇痛效果、睡眠质量、舒芬太尼使用总量明显优于切口局部浸润联合自控静脉镇痛与单纯静脉镇痛。

Objective To select the appropriate postoperative analgesia,through the application of different methods in the postoperative analgesia of the patients with breast cancer.Methods Ninety female patients undergoing unilateral breast cancer radical surgery in general anesthesia,aged 35-60 years,weighing 45-80 kg,falling into ASA physical status Ⅰ or Ⅱ,were randomly divided into simple intravenous postoperative analgesia group（group P,n=30）,local infiltration plus intravenous postoperative analgesia group（group R,n=30）,ultrasound guided thoracic nerve block plus intravenous postoperative analgesia（group TP,n=30）,group P used dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group R used 0.375%ropivacaine 20 ml local infiltration added dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group TP used 0.375% ropivacaine 20 ml vertebral side block added dexmedetomidine 2μg/kg plus sufentanil 2μg/kg.The VAS scores and Ramsay score was recorded 6,12,24,48 hafter surgery,the deep sleep quality score at preoperative postoperative 24 hand 48 h,the number of postoperative analgesia pump pressure,the use of sufentanil and the nausea,vomiting,itching, bradycardia,respiratory depression happened in 24 h were documented.Results The VAS scores in groups R and TP 6 hafter surgery were significantly lower than that of group P.The VAS scores in group TP 12 hafter surgery were significantly lower than that of groups R and P（P0.05）.The sedation scores were not statistically significant among the three groups.The deep sleep quality scores at 24 hin group TP were significantly lower than those of groups R and P（P〈0.05）.The number of compressions and the use of the sufentanil in 24 hafter surgery in group TP were significantly lower than those of groups R and P,and that in group R was significantly lower than that in group P（P0.05）.The incidence of nausea,vomiting,itching,bradycardia,respiratory depression were not statistically significant in 24 h,and there were no postoperative complications related to neurologic blocking of lateral vertebral nerve.Conclusion Three methods were safe and effective for postoperative analgesia in patients with radical surgery breast cancer.Ultrasound guided by thoracic nerve block combined intravenous postoperative analgesia was obviously better than local infiltration plus infiltration postoperative analgesia and infiltration postoperative analgesia in terms of postoperative analgesia,quality of sleep and the number of sufentanil.