胸膜横突中点阻滞在乳腺癌根治术中的安全性及有效性

Safety and efficacy of pleural transversal midpoint block in radical mastectomy

目的:探究胸膜横突中点阻滞(MTP)在乳腺癌根治术中的安全性及有效性。方法:选取行乳腺癌手术患者70例为研究对象,随机分为研究组与对照组各35例,研究组在麻醉诱导后给予MTP,对照组行常规麻醉方案。主要观察指标为围术期加入的阿片类镇痛药量,次要观察指标为:①术后1 h、2 h、4 h、12 h、24 h数字分级法(NRS评分);②术后镇痛药物的使用情况;③术后不良反应(恶心、呕吐、头晕、寒战、气胸、血肿、全脊麻)。结果:与对照组比较,研究组在术中瑞芬太尼及丙泊酚用量更低,差异有统计学意义(P<0.05);两组在手术时间比较差异无统计学意义(P>0.05);与对照组比较,研究组患者术后1 h、2 h和4 h的疼痛视觉模拟评分法(VAS)评分更低,差异有统计学意义(P<0.05);两组术后12 h、24 h的VAS评分比较,差异无统计学意义(P>0.05);与对照组比较,研究组患者在术后发生恶心、呕吐、头晕的概率更小,差异有统计学意义(P<0.05)。结论:与常规全身麻醉方法比较,超声引导下MTP可以有效减少乳腺癌改良根治术患者术中的阿片类镇痛药的用量,同时在术后镇痛效果更好,且术后不良反应的发生率更低。

Objective To explore the safety and effectiveness of pleural transversal midpoint block in radical mastectomy.Method 70 patients undergoing breast cancer surgery were selected as the research subjects.The patients were divided into study group and control group according to random number table method.There were 35 cases in each group.After induction of anesthesia,the study group was given pleural transitory intermediate point block(MTP),and the control group was received routine anesthesia regimen.The primary outcome measure was the amount of opioid analgesic drugs added during the perioperative period,and the secondary outcome measure was①1,2,4,12,24 h postoperative digital grading(NRS score);②Postoperative analgesic drug use;③Postoperative adverse reactions(Nausea,vomiting,dizziness,chills,pneumothorax,hematoma,general spinal anesthesia).Results Compared with the control group,the dosage of remifentanil and propofol in the study group was lower,and the difference was statistically significant(P<0.05).There was no significant difference in operation time between the two groups(P>0.05).Compared with the control group,VAS scores in the study group at 1h,2h and 4h after surgery were lower,and the difference was statistically significant(P<0.05).There was no significant difference in VAS scores at 12h and 24h between the two groups(P>0.05).Compared with the control group,the probability of postoperative nausea,vomiting and dizziness in patients with MTP block in the study groupwas lower,and the difference was statistically significant(P<0.05).Conclusion Compared with conventional general anesthesia,ultrasound-guided pleural transversal midpoint block can effectively reduce the amount of opioid analgesics in patients undergoing modified radical mastectomy,At the same time,the postoperative analgesia is better,and the incidence of postoperative adverse reactions is lower.