右美托咪定联合前锯肌平面阻滞在乳腺癌根治术中的应用效果

Effect of dexmedetomidine combined with anterior serratus block in radical mastectomy for breast cancer

目的观察右美托咪定联合前锯肌平面阻滞在乳腺癌根治术中的应用效果。方法选取2021年1月—2022年1月于漳州市医院接受乳腺癌根治术治疗的乳腺癌患者96例,依照随机分组对照原则分为观察组和对照组,各48例。对照组予常规全身麻醉,观察组采用右美托咪定联合前锯肌平面阻滞。比较2组术后6、12、24、48 h内静息与运动状态视觉模拟疼痛(VAS)评分,术中丙泊酚、瑞芬太尼,术后首次按压镇痛泵时间与舒芬太尼应用剂量,患者疼痛控制满意度及不良反应。结果观察组术后6 h、12 h静息与运动状态下VAS评分均低于同期对照组(P<0.01),2组术后24 h、48 h静息与运动状态下VAS评分比较差异无统计意义(P>0.05);2组术后24 h、48 h静息与运动状态下VAS评分均分别高于本组术后6 h、12 h,除外对照组术后12 h与24 h项,其余各项差异均有统计学意义(P均<0.01);观察组丙泊酚、瑞芬太尼、舒芬太尼用药量均少于对照组(P<0.01);术后首次按压镇痛泵时间、患者疼痛控制满意度评分长于或高于对照组(P均<0.01);2组不良反应总发生率(4.17%vs.8.33%)比较差异无统计学意义(χ^(2)=0.711,P=0.677)。结论右美托咪定联合前锯肌平面阻滞在乳腺癌根治术中的应用效果良好,能减轻患者术后疼痛,减少麻醉药物使用剂量,提高疼痛控制满意度,且未增加不良反应发生风险,值得临床推广应用。

Objective To observe the effect of dexmedetomidine combined with anterior serratus block in radical mastectomy for breast cancer.Methods Ninety-six patients with breast cancer who received radical mastectomy in Zhangzhou Hospital from January 2021 to January 2022 were selected.According to the principle of random grouping and control,they were divided into observation group and control group,with 48 cases in each group.The control group was given routine general anesthesia,and the observation group was given dexmedetomidine combined with anterior serratus plane block.VAS scores of resting state and exercise state were compared between the two groups within 6,12,24 and 48 hours after operation,the application doses of propofol and remifentanil during operation,the time of first pressing the analgesic pump after operation and the application dose of sufentanil,the patients′satisfaction with pain control and adverse reactions were compared.Results The VAS scores of the observation group at 6 h and 12 h after operation in resting state and exercise state were lower than those of the control group at the same time(P<0.01).There was no significant difference in VAS scores between the two groups at 24 h and 48 h after operation in resting state and in exercise state(P>0.05).The VAS scores of the two groups at 24 h and 48 h after operation in resting state and in exercise state were higher than those at 6 h and 12 h after operation in this group respectively,except for the 12 h and 24 h after operation in the control group,the other differences were statistically significant(all P<0.01).The dosage of propofol,remifentanil and sufentanil in the observation group was less than that in the control group(P<0.01).The time of first pressing the analgesic pump and the score of patients′satisfaction with pain control were longer or higher than those in the control group(all P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups(4.17%vs.8.33%,χ^(2)=0.711,P=0.677).Conclusion Dexmedetomidine combined with anterior serratus muscle plane block in radical mastectomy for breast cancer has a good effect.It can reduce the postoperative pain,reduce the dosage of narcotic drugs,improve the satisfaction of pain control,and does not increase the risk of adverse reactions.It is worthy of clinical application.