超声引导下不同剂量右美托咪定复合罗哌卡因TTP-PECS对乳腺癌改良根治术后镇痛效果及早期康复的影响

Effect of Different Doses of Dexmedetomidine Combined with Ropivacaine TTP-PECS under Ultrasound Guidance on Postoperative Analgesia and Early Rehabilitation after Modified Radical Mastectomy

探讨超声引导下不同剂量右美托咪定复合罗哌卡因胸横肌平面-胸神经阻滞(TTP-PECS)在乳腺癌改良根治术后镇痛效果及早期康复的影响。选取该院2018年12月~2020年1月行乳腺癌根治术的患者100例,采用随机数表法均分为A组、B组、C组、对照组,各25例。所有患者均行超声引导下TTP-PECS联合全身麻醉,给予对照组0.375%的罗哌卡因20 mL,给予A组0.5μg/kg右美托咪定复合罗哌卡因,给予B组1.0μg/kg右美托咪定复合罗哌卡因,给予C组2.0μg/kg右美托咪定复合罗哌卡因。比较4组患者术后2~24 h的疼痛评分、平均动脉压(MAP)、心率(HR)等血流动力学指标变化,统计不良反应发生率。术后2 h,A组、B组、C组与对照组的疼痛评分、血流动力学比较差异无显著性(P>0.05);术后6~24 h,A组、B组、C组的疼痛评分、平均动脉压(MAP)、心率(HR)水平均低于对照组,且B组、C组的疼痛评分、平均动脉压(MAP)、心率(HR)水平均低于A组,差异均有显著性(P<0.05);B组、C组的上述指标比较差异无显著性(P>0.05);A组、B组、C组与对照组的不良反应发生率比较,差异无显著性(P>0.05)。给予乳腺癌改良根治术后患者超声引导下1.0~2.0μg/kg右美托咪定复合罗哌卡因TTP-PECS的镇痛效果显著,能有效稳定患者的血流动力学,促进患者的术后恢复。

To investigate the effect of ultrasound-guided dexmedetomidine combined with ropivacaine thoracic transverse muscle block thoracic nerve block(TTP-PECS)on postoperative analgesia and early rehabilitation after modified radical mastectomy,100 patients who underwent radical mastectomy in January December 2018 in the authors'hospital were randomly divided into A group,B group,C group and control group with 25 cases in each group by random number table.All patients underwent ultrasound-guided TTP-PECS combined with general anesthesia,and were given 0.375% ropivacaine 20 mL in control group,0.5μg/kg dexmedetomidine combined with ropivacaine in group A,1.0μg/kg dexmedetomidine combined with ropivacaine in group B and 2.0μg/kg dexmedetomidine combined with ropivacaine in group C.The changes of pain score,MAP and HR were compared in the four groups after operation,and the incidence of adverse reactions was statistically analyzed.Two hours after operation,there was no significant difference in pain score and hemodynamics between group A,group B,group C and the control group(P>0.05).From 6 to 24 hours after operation,the pain score,mean arterial pressure(MAP)and heart rate(HR)in group A,group B and group C were lower than those in the control group,and the pain score,mean arterial pressure(MAP)and heart rate(HR)in group B and group C were lower than those in group A(P<0.05).There was no significant difference in the above indexes between group B and group C(P>0.05).There was no significant difference in the incidence of adverse reactions between group A,group B and group C and the control group(P>0.05).The analgesic effect of 1.0~2.0μg/kg dexmedetomidine combined with ropivacaine TTP-PECS in patients after modified radical mastectomy is significant,it can effectively stabilize the hemodynamics of patients and promote the postoperative recovery of patients,which is application of promotion.