超声下肋间神经阻滞复合喉罩全麻在乳腺癌手术中的应用

Application of ultrasound-guided intercostal nerve block combined with laryngeal mask airway anesthesia in the lumpectomy

目的:探讨超声下肋间神经阻滞用于乳腺癌根治术的麻醉效果。方法:选择2015年1月~2016年12月本院择期行乳腺癌根治术患者90例,随机分成(1)组、(2)组、(3)组,每组30例,(1)组超声肋间神经阻滞+喉罩全麻、(2)组传统盲法穿刺肋间神经阻滞+喉罩全麻、(3)组喉罩全麻。比较(1)组、(2)组、(3)组麻醉诱导前(T0)、切皮时(T1)、切皮后1h(T2)、拔除喉罩后5min(T3)的生命体征和应激反应相关指标水平的波动情况以及(1)组、(2)组的肋间神经阻滞效果。结果:(3)组T3时的MAP和HR水平明显高于T0时的水平,(3)组T3时的MAP和HR水平明显高于(1)组、(2)组;(1)组、(2)组T3时的A-Ⅱ水平明显高于T0时的水平,(3)组T1、T3时的Cor和A-Ⅱ水平均明显高于T0时的水平,(3)组T1、T3时的Cor和A-Ⅱ水平明显高于(1)组、(2)组;(1)组的阻滞起效时间、阻滞完善时间均明显快于(2)组,(1)组的镇痛维持时间明显长于(2)组;(1)组镇痛完全,(2)组有4例镇痛不全。结论:肋间神经阻滞复合喉罩全麻能更好维持术中血压和呼吸循环的稳定、减轻应激,尤其是超声下肋间神经阻滞的镇痛效果优于传统盲法穿刺肋间神经阻滞。

Objective To investigate the effect of ultrasound-guided intercostal nerve block in the lumpectomy. Methods The 90 cases of patients who underwent lumpectomy admitted to hospital from January 2015 to December 2016 were randomly divided into three group, 30 cases in each group. The groupⅠwas given ultrasound-guided intercostal nerve block and laryngeal mask general anesthesia, the groupⅡwas given traditional intercostal nerve block and laryngeal mask general anesthesia, the group Ⅲ was only given laryngeal mask general anesthesia. The changes of vital signs and stress response related indexes before anesthesia induction(T0), skin incision(T1), 1 h post-skin incision(T2), after the removal of LMA 5 min(T3) in the three group, and the effect of intercostal nerve block between groupⅠand groupⅡwere observed and recorded. Results The MAP and HR at T3 in group Ⅲ were significantly higher than those at T0, and that were significantly higher than those in groupⅠand groupⅡat T3; the Cor and A-Ⅱat T1 and T3 in group Ⅲ were significantly higher than those at T0, and that were significantly higher than those in groupⅠand groupⅡat T1 and T3; the onset time and blocking perfect time in groupⅠwere significantly faster than those in group; the duration of analgesia in groupⅠwere significantly longer than that in group; analgesia in groupⅠwas complete, and there were 4 cases with incomplete analgesia in group Ⅱ. Conclusion Intercostal nerve block combined with laryngeal mask airway anesthesia in the lumpectomy can better maintain intraoperative blood pressure and respiratory stability, and reduce stress; especially the ultrasound-guided intercostal nerve block analgesia is better than the traditional blind puncture of intercostal nerve block.