应用自控静脉镇痛对乳腺癌改良根治术后患者恢复的影响

Effect of Patient-controlled Intravenous Analgesia on Postoperative Recovery after Modified Radical Mastectomy for Breast Cancer

目的探究自控静脉镇痛对乳腺癌患者行改良根治术后恢复的影响。方法选取行乳腺癌改良根治术的患者共87例,随机分为观察组(n=43)与对照组(n=44)。2组患者均在全麻状态下进行手术。观察组术后应用自控静脉镇痛,对照组无静脉镇痛。比较2组患者术后2 h、4 h、8 h、12 h、24 h、48 h的VAS评分与头晕、嗜睡、恶心呕吐、便秘、烦躁不安的发生情况。患者出院后,对其进行24个月的电话随访,统计随访期间2组患者的死亡人数与生存时间,采用Kaplan-Meier法和对数秩检验(log-rank test)进行生存分析。结果观察组患者的术后8 h、12 h、24 h、48 h的VAS评分显著低于对照组,差异具有统计学意义(P <0. 05);观察组术后头晕、嗜睡、恶心呕吐、便秘、烦躁不安及总不良反应发生率均显著低于对照组,差异具有统计学意义(P <0. 05)。生存分析结果表明,术后应用自控静脉镇痛可显著提高患者的生存率(P <0. 05)。结论术后应用自控静脉镇痛可减轻乳腺癌患者的术后疼痛及降低术后不良反应发生率,并改善患者预后,值得在临床推广使用。

Objective To explore the effect of patient-controlled intravenous analgesia on the recovery of breast cancer patients after modified radical mastectomy. Methods 87 patients with breast cancer undergoing modified radical mastectomy were randomly divided into the observation group( n = 43) and the control group( n = 44). The 2 groups were operated under general anesthesia. Patients in the observation group were given intravenous analgesia after operation,while the control group received no intravenous analgesia. The VAS scores at 2,4,8,12,24 and 48 hours after operation,and dizziness,lethargy,nausea,vomiting,constipation,fidgety were compared between the 2 groups. After discharged from hospital,the patients were followed up for 24 months. The number of deaths in the 2 groups during the follow-up period was counted. The survival analysis was performed by Kaplan-Meier method and log-rank test. Results The VAS scores of the observation group at 8,12,24 and 48 hours after operation were significantly lower than those of the control group( P < 0. 05). The incidence of dizziness,drowsiness,nausea,vomiting,constipation,restlessness and total adverse reactions were significantly reduced after operation( P < 0. 05). Survival analysis showed that postoperative patient-controlled intravenous analgesia can significantly improve the survival rate,and the difference were statistically significant( P < 0. 05). Conclusion Postoperative application of patient-controlled intravenous analgesia can reduce postoperative pain and incidence of adverse reactions in breast cancer patients,and improve the prognosis of patients,which is worthy of clinical application.