超声引导下肋间神经阻滞复合右美托咪定在乳房肿块切除手术中的应用

Application of Ultrasound-guided Intercostal Nerve Block Combined with Dexmedetomidine in Breast Lumpectomy

目的研究对乳房肿块切除术患者给予超声引导下右美托咪定和肋间神经阻滞麻醉的效果。方法于2019年9月—2020年9月在该院患者中随机抽取70例,分为两组,对照组给予右美托咪定麻醉,观察组联合超声下肋间神经阻滞复合麻醉,对比两组镇痛镇静效果和HR、MAP变化,麻醉起效时间,术后不良反应。结果观察组T2时间HR(67.14±3.25)次/min,T3时间HR(68.97±3.58)次/min,T4时间HR(71.20±2.63)次/min,均低于对照组;观察组T2时间MAP(71.36±3.28)mmHg,T3时间MAP(88.79±3.16)mmHg,显著低于对照组,差异有统计学意义(t=11.332、16.059、8.520、15.639、20.428,P<0.05)。观察组T2时间RAMSAY(1.85±0.12)分,T3时间RAMSAY(2.34±0.20)分,T4时间RAMSAY(3.08±0.31)分,明显高于对照组;观察组T3时间VAS(3.21±0.28)分,T4时间VAS(1.40±0.38)分,显著低于对照组,差异有统计学意义(t=6.849、8.332、18.407、19.106、15.980,P<0.05)。对照组阻滞起效时间(5.29±0.86)min,完全阻滞时间(13.60±1.58)min,镇痛持续时间(4.15±0.59)min;观察组阻滞起效时间(2.85±0.71)min,完全阻滞时间(9.03±1.14)min,镇痛持续时间(5.38±0.75)min,差异有统计学意义(t=12.945、13.877、7.626,P<0.05)。对照组出现恶心呕吐1例(2.86%),观察组出现恶心呕吐1例(2.86%),两组不良反应对比差异无统计学意义(χ^(2)=0.000,P=1.000)。结论对乳房肿物切除术患者联合使用右美托咪定和肋间神经阻滞可有效达到麻醉效果,可保证心率和血压的稳定,达到更理想的镇静镇痛效果,具有较高临床价值。

Objective To study the effect of ultrasound guided Dexmedetomidine and intercostal nerve block anesthesia in patients with breast mass resection.Methods On September 2019 to September 2020,70 patients in the hospital were randomly selected into two groups.The control group was given dexmedetomidine anesthesia,the observation group combined with ultrasound intercostal nerve block combined anesthesia,and the analgesic and sedative effects and HR,MAP changes,anesthesia onset time,adverse reactions afte surgery of the two groups were compared.Results In the observation group,HR at T2 time(67.14±3.25)times/min,HR at T3 time(68.97±3.58)times/min and HR at T4 time(71.20±2.63)times/min were lower than those in the control group,the T2 time MAP(71.36±3.28)mmHg and T3 time MAP(88.79±3.16)mmHg of the observation group were significantly lower than those of the control group,and the difference was statistically significant(t=11.332,16.059,8.520,15.639,20.428,P<0.05).RAMSAY at T2,T3 and T4 were significantly higher than those in the control group(1.85±0.12)points,(2.34±0.20)points,(3.08±0.31)points;the VAS at T3 and T4 in the observation group were(3.21±0.28)points and(1.40±0.38)points,respectively,significantly lower than those in the control group,the difference was statistically significant(t=6.849,8.332,18.407,19.106,15.980,P<0.05).In the control group,the effective time was(5.29±0.86)min,the complete time was(13.60±1.58)min,and the duration of analgesia was(4.15±0.59)min;the effective time,complete time and duration of analgesia in the observation group were(2.85±0.71)min,(9.03±1.14)min and(5.38±0.75)min,and the differences were statistically significant(t=12.945,13.877,7.626,P<0.05).There was 1 case of nausea and vomiting in the control group(2.86%)and 1 case of nausea and vomiting in the observation group(2.86%).There was no statistical significance in the comparison of adverse reactions between the two groups(χ^(2)=0.000,P=1.000).Conclusion The combined use of dexmedetomidine and intercostal nerve block in patients with mastectomy can effectively achieve the anesthetic effect,keeping heart rate and blood pressure stable,achieving a better sedative and analgesic effect,and it has high clinical value.