两种肋间神经阻滞方法对乳腺癌术后镇痛效果临床对照研究

Two intercostal nerve block methods for postoperative analgesic effect of breast cancer

目的比较右美托咪定和舒芬太尼复合罗哌卡因肋间神经阻滞对乳腺癌术后镇痛的临床效果。方法回顾性分析自2014年3月至2015年12月延安大学附属医院收治的105例乳腺癌根治术的患者的临床资料。根据使用麻醉药物的不同分为单纯应用罗哌卡因组(R组)、舒芬太尼复合罗哌卡因组(S组)和右美托咪定复合罗哌卡因组(D组),每组各35例。记录3组患者术后各时间点安静和90°翻身活动时的疼痛视觉模拟评分(VAS)和Ramsay镇静评分,以及不良反应的发生情况。结果 3组患者在术后1、2、8、12、24、48 h的安静和90°翻身活动时的VAS评分及Ramsay镇静评分比较,S组和D组均显著低于R组,差异有统计学意义(P<0.05),S组和D组比较,差异无统计学意义(P>0.05)。结论右美托咪定和舒芬太尼复合罗哌卡因肋间神经阻滞用于乳腺癌术后镇痛时,均能显著增强罗哌卡因的镇痛和镇静效果,且安全性好。

Objective To compare the effect of dexmedetomidine and sufentanil combined with ropivacaine for postoperative analgesia after redical mastectomy in breast cancer patients that was induced by intercostal nerve block. Methods A retrospective study was performed on 105 cases of patients who were admitted and underwent breast cancer surgery from March 2014 to December 2015. Depending on the different use of narcotic drugs,patients were divided into the simple ropivacaine group（ R group）,sufentanil combined ropivacaine group（ S group） and dexmedetomidine combined ropivacaine group（ D group）,with 35 cases in each group. The visual analogue score（ VAS） and the Ramsay sedation score of 3 groups of patients were recorded respectively in quiet and 90 degree turn over activities after operation at each time point,and the adverse reactions were recorded. Results For the three groups of patients in quiet and 90 degree turning over activities,at 1,2,8,12,24 and 48 hours,the VAS score of S group and D group was significantly lower than that of R group（ P 〈 0. 05）,and there was no significant difference of VAS score between S group and D group（ P 〉 0. 05）. Conclusion Dexmedetomidine and sufentanil combined with ropivacaine for postoperative analgesia after redical mastectomy in breast cancer patients that induced by intercostal nerve block,two drugs can significantly enhance the analgesic and sedative effect of ropivacaine and has good security.