超声引导下胸椎旁神经阻滞复合全身麻醉对老年乳腺癌患者麻醉效果的影响

Effects of ultrasound-guided thoracic paravertebral nerve block anesthesia combined with general anesthesia on elderly patients with breast cancer

目的:观察超声引导下胸椎旁神经阻滞复合全身麻醉对老年乳腺癌患者麻醉效果的影响。方法:回顾性分析2017—2019年100例行乳腺癌改良根治术治疗的老年乳腺癌患者的临床资料,按麻醉方法不同分为对照组和观察组各50例。对照组行全身麻醉,观察组在超声引导下行胸椎旁神经阻滞麻醉复合全身麻醉,比较两组不同时间点血流动力学指标水平、应激反应指标水平、术后疼痛和镇静评分,及不良反应发生率。结果:T2、T3、T4时,观察组心率、血管紧张素Ⅱ和皮质醇水平均低于对照组,平均动脉压水平高于对照组,差异有统计学意义(P<0.05);观察组术后2、6、12 h的视觉模拟评分法评分明显低于对照组,Ramsay镇静评分明显高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为8.00%(4/50),明显低于对照组的28.00%(14/50),差异有统计学意义(P<0.05)。结论:胸椎旁神经阻滞麻醉复合全身麻醉对老年乳腺癌患者麻醉效果确切,能维持术中血流动力学稳定,减轻炎症反应和应激反应,降低术后疼痛程度,维持良好的镇静效果,且安全性好。

Objective:To investigate effects of ultrasound-guided thoracic paravertebral nerve block anesthesia combined with general anesthesia on elderly patients with breast cancer.Methods:A retrospective analysis of the clinical data of 100 elderly patients with breast cancer,who underwent modified radical mastectomy from 2017 to 2019,was performed.According to different anesthesia methods,they were divided into control group and observation group,50 cases in each.The control group received general anesthesia,while the observation group underwent ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia.The hemodynamic index levels,stress response index levels,postoperative pain and sedation scores,and the incidence of adverse reactions were compared between the two groups at different time points.Results:At T2,T3 and T4,the heart rate and the levels of angiotensin II and cortisol of the observation group were lower than those of the control group;the mean arterial pressure level was higher than that of the control group;and the differences were statistically significant(P<0.05).2,6,and 12 hours after the surgery,the pain scores of the observation group were significantly lower than those of the control group;the Ramsay sedation scores were significantly higher than those of the control group;and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was 8.00%(4/50),which was significantly lower than 28.00%(14/50)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Ultrasound-guided thoracic paravertebral nerve block anesthesia combined with general anesthesia for the elderly patients with breast cancer is definitely effective.It can maintain the intraoperative hemodynamic stability,reduce the inflammatory reaction and stress reaction,reduce the postoperative pain,and maintain the good sedation effect with high safety.