本文選題：胸椎旁阻滯　切入點：超聲引導(dǎo)　出處：《第三軍醫(yī)大學(xué)學(xué)報》2015年18期

【摘要】：目的評估超聲引導(dǎo)下間隔平面胸椎旁阻滯聯(lián)合全憑靜脈麻醉(total intravenous anesthesia,TIVA)用于乳腺癌改良根治術(shù)對術(shù)后疼痛的影響。方法 60例行乳腺癌根治術(shù)18~85歲女性患者,ASAⅠ~Ⅲ級,按隨機數(shù)字表法分為2組,每組30例。靜吸復(fù)合組行靜吸復(fù)合全身麻醉,胸椎旁阻滯組行多平面胸椎旁阻滯聯(lián)合TIVA,術(shù)中自主呼吸。2組術(shù)后鎮(zhèn)痛均采用患者自控靜脈鎮(zhèn)痛(patient-controlled intravenous analgesia,PCIA)。在T1(入室時)、T2(手術(shù)開始前即刻)、T3(切皮后5 min)、T4(腋窩清掃時)、T5(手術(shù)結(jié)束時)、T6(拔除喉罩時)、T7(轉(zhuǎn)出PACU時)記錄患者的心率、血壓、脈搏氧飽和度(Sp O2)、呼氣末二氧化碳(PETCO2)和腦電雙頻譜指數(shù)(bispectral index,BIS);在T8(術(shù)后2 h)、T9(術(shù)后4 h)、T10(術(shù)后8 h)、T11(術(shù)后16 h)、T12(術(shù)后24 h)對患者進行VAS疼痛評分。記錄術(shù)中舒芬太尼用量,PACU停留時間,PCIA舒芬太尼用量和PCIA按壓次數(shù)及術(shù)后麻醉相關(guān)并發(fā)癥情況。結(jié)果在手術(shù)開始前即刻,胸椎旁阻滯組心率明顯高于靜吸復(fù)合組,在手術(shù)結(jié)束時,胸椎旁阻滯組心率明顯低于靜吸復(fù)合組(P0.05)。血壓、Sp O2、PETCO2和BIS在各時間點差異無統(tǒng)計學(xué)意義(P0.05)。胸椎旁阻滯組在術(shù)后2、4 h和術(shù)后8 h平靜休息和咳嗽時VAS評分均低于靜吸復(fù)合組。胸椎旁阻滯組的術(shù)中舒芬太尼用量、PACU停留時間、PCIA舒芬太尼用量和按壓次數(shù)均低于靜吸復(fù)合組(P0.05)。胸椎旁阻滯組術(shù)后麻醉相關(guān)并發(fā)癥發(fā)生例數(shù)少于靜吸復(fù)合組,但2組發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論超聲引導(dǎo)下胸椎旁阻滯可安全有效的應(yīng)用于乳腺癌改良根治術(shù),不僅可以有效減少圍術(shù)期阿片類藥物的用量,降低PACU停留時間,而且能改善術(shù)后急性疼痛,有利于患者術(shù)后恢復(fù)。
[Abstract]:Objective to evaluate the effect of total intravenous anesthesia combined with total total intravenous anesthesia on postoperative pain after radical mastectomy in 60 women (1885 years old) undergoing radical mastectomy. According to the method of random digital table, the patients were divided into two groups, 30 cases in each group, and 30 cases in each group. In the paraspinal thoracic block group, the patient controlled intravenous analgesia was used for postoperative analgesia with patient-controlled intravenous analgesia. At the end of the operation, the heart rate of the patient was recorded. Blood pressure, Pulse oxygen saturation (SPO _ 2), end-expiratory carbon dioxide (PETCO _ 2) and bispectral index (bispectral index) were used in T8 (2 h after operation) and T9 (4 h after operation). The pain scores of VAS were assessed at 8 h after operation (16 h after operation) and 24 h after operation. The dosage of sufentanil was recorded during operation. The duration of stay, the dosage of sufentanil, the number of PCIA compressions, and the complications associated with anesthesia after operation. The heart rate of thoracic paravertebral block group was significantly higher than that of static aspiration group, and at the end of operation, The heart rate of thoracic paravertebral block group was significantly lower than that of static aspiration combined group (P 0.05). There was no significant difference in blood pressure, spo _ 2, PETCO _ 2 and BIS at different time points. The VAS score of thoracic paraspinal block group was lower than that of rest and cough group at 24 h and 8 h after operation. The dosage of sufentanil and the residence time of PACU in the thoracic paravertebral block group were lower than those in the control group (P 0.05). The incidence of postoperative anesthetic complications in the paravertebral thoracic block group was less than that in the control group. Conclusion Ultrasound-guided paravertebral block can be used safely and effectively in modified radical mastectomy for breast cancer. It can not only reduce the dosage of opioid drugs during perioperative period, but also reduce the residence time of PACU. Moreover, it can improve the acute pain after operation, and is beneficial to the recovery of patients after operation.
【作者單位】： 南方醫(yī)科大學(xué)南方醫(yī)院麻醉科;
【分類號】：R737.9;R614

【共引文獻】

相關(guān)期刊論文 前10條

1 張相民;藍小林;羅克R，

本文編號：1677405