罗哌卡因联合右美托咪定超声引导SAPB对乳腺癌术后镇痛效果的研究

Study on the effects of ropivacaine combined with dexmedetomidine on the postoperative analgesic effect in breast cancer under ultrasound-guided SAPB

目的研究罗哌卡因联合右美托咪定在超声引导前锯肌平面阻滞下对乳腺癌术后镇痛效果的影响。方法选取2017年1月~2018年3月于我院择期行乳腺癌根治术的患者200例作为研究对象,随机分为两组:罗哌卡因组(R组)和罗哌卡因联合右美托咪定组(RD组),每组100例。术后两组患者均在超声引导下行SAPB,R组给予0.3%罗哌卡因20 mL,RD组给予0.3%罗哌卡因复合0.5μg/kg右美托咪定20 mL。比较R组和RD组患者术后2 h、6 h、12 h、24 h及48 h各时间点的视觉模拟评分(VAS)、镇静评分(Ramsay)、舒适度评分(BCS)及镇痛泵有效按压次数,并记录两组患者的不良反应发生情况。根据所得数据采用SPSS 20.0统计学软件进行分析处理。结果RD组在术后各时点的VAS、Ramsay镇静评分和镇痛泵有效按压次数均低于R组,BCS均高于R组,各指标在24 h和48 h时点比较,差异有统计学意义(P<0.05);RD组在术后48 h内的相关总不良反应发生率明显低于R组(P<0.05)。结论罗哌卡因联合右美托咪定用于SAPB能明显减轻乳腺癌术后疼痛,延长镇痛效果,提高舒适度,降低术后恶心呕吐和低血压等相关不良反应发生率,更有利于患者康复。

Objective To study the effects of ropivacaine combined with dexmedetomidine on postoperative analgesic effect of breast cancer under ultrasound-guided serratus plane block(SAPB).Methods A total of 200 patients who were given elective radical mastectomy in our hospital from January 2017 to March 2018 were selected as study subjects.They were randomly divided into two groups,ropivacaine group(R group)and ropivacaine combined with dexmedetomidine group(RD group),with 100 cases in each group.After surgery,both groups of patients were given ultrasound-guided SAPB.The R Group was given 20 mL of 0.3%ropivacaine,and the RD group was given 20 mL of 0.3%ropivacaine combined with 0.5μg/kg dexmedetomidine.The visual analogue scale(VAS),Ramsay score(Ramsay),comfort score(BCS)and the number of effective presses of the analgesic pump were compared between the R group and the RD group at 2 h,6 h,12 h,24 h and 48 h after surgery,and the incidence rate of adverse reactions in the two groups of patients was recorded.According to the data obtained,the analysis was performed using SPSS 20.0 statistical software.Results The VAS,Ramsay sedation score and effective number of presses of analgesic pumps in the RD group were lower than those in the R group at all time points after surgery,and the BCS was higher than the R group.The differences in each index at 24 h and 48 h were statistically significant(P<0.05);The total incidence rate of adverse reactions in the RD group was significantly lower than that in the R group within 48 hours after surgery(P<0.05).Conclusion Ropivacaine combined with dexmedetomidine for SAPB can significantly reduce postoperative pain in breast cancer,prolong analgesic effect and improve comfort,and reduce the incidence rate of postoperative nausea,vomiting and hypotension,which is more conducive to patients'recovery.