超声引导前锯肌平面阻滞和竖脊肌平面阻滞在乳腺癌根治术中的镇痛效果比较

Comparison of the analgesic effect of anterior serratus planar block and erector spine planar block guided by ultrasound during radical mastectomy for breast cancer

目的:比较超声引导前锯肌平面阻滞(SAPB)和竖脊肌平面阻滞(ESPB)在乳腺癌根治术中的镇痛效果。方法:选取本院2016年7月-2018年3月收治的94例乳腺癌患者,随机分为两组,患者术前禁止饮食,进入手术室后常规检测及麻醉诱导,在上述麻醉基础上SAPB组进行超声引导前锯肌平面阻滞,ESPB组进行超声引导竖脊肌平面阻滞治疗。记录围术期生命体征指标、围手术期镇痛、镇静药物用量、术后及治疗费用。结果:ESPB组围术期出血量、丙泊酚、瑞芬太尼及舒芬太尼用量均低于SAPB组(P<0.05)。手术切皮即刻、手术开始30 min、手术开始1 h、手术结束时和苏醒并拔管即刻,SAPB组MAP、HR均低于ESPB组(P<0.05),ESPB组围术期MAP、HR无明显变化,SAPB组从T1即刻明显下降(P<0.05)。两组各时刻RR、SpO2比较无差异(P>0.05)。术后两组患者皮缘坏死、切口感染、嗜睡、皮肤瘙痒及呼吸抑制比较无差异(P>0.05),ESPB组苏醒时间、拔管时间、术后2 hVAS评分、皮下积液、寒战、恶心呕吐、住院日和治疗费用均低于SAPB组(P<0.05);结论:ESPB治疗能有效降低围术期出血量及维护患者生命体征,降低术后并发症及不良反应概率,缓解患者疼痛,并缩短住院时间,降低治疗费用。

Objective:To compare the analgesic effects of serratus planar block(SAPB)and erector spine planar block(ESPB)guided by ultrasound during radical mastectomy for breast cancer.Methods:94 women with breast cancer were selected as the research objects and were randomly divided into two groups(47 cases in each group)from July 2016 to March 2018.The women in the two groups were forbidden diet before operation,and were given routine examination and anesthesia induction after entering the operating room.Then the women in the study group had received ESPB guided by ultrasound and the women in the control group had received SAPB guided by ultrasound.The index of perioperative vital signs,perioperative analgesia effect,dosage of sedative,and treatment costs of women in both groups were recorded.Result:The perioperative blood loss,and the dosage of propofol,remifentanil and sufentanil of women in the study group were significant lower than those of women in the control group(P<0.05).There were no significant different in the values of MAP and HR before anesthesia of women between the two groups(P>0.05).The values of MAP and HR of women when cut skin instantly of surgery,30 min and 1 h after surgery beginning,at the end of surgery,or when awakening and extubation instantly in the control group were significant lower than those of women in the study group(P<0.05).The values of perioperative MAP and HR of women in the study group had no change,but those of women in the control group had decreased significantly from T1(P<0.05).There were no significant different in the values of RR and SpO2 of women at each time between the two groups(P>0.05).There were significant different in the rates of postoperative skin edge necrosis,incision infection,lethargy,skin pruritus,and respiratory inhibition of women between the two groups(P>0.05).The awakening time,extubation time,VAS score 2 h after operative,rates of subcutaneous hydrops,chills,and nausea and vomiting,hospitalization time,and treatment costs of women in the study group were all significant lower than those of women in the control group(P<0.05).Conclusion:ESPB can effectively reduce perioperative bleeding and maintain vital signs of women,can reduce the rates of complications and adverse reactions,can relieve pain and shorten hospitalization time,and can reduce treatment costs.