胸神经阻滞和肋间神经阻滞对乳腺癌根治术患者血流动力学、术后镇痛及呼吸功能的对比研究

目的:比较胸神经阻滞和肋间神经阻滞对乳腺癌根治术患者血流动力学、术后镇痛以及呼吸功能的影响,为乳腺癌根治术患者的临床麻醉选择提供参考。方法:选择2017年3月至2018年3月医院收治的120例行乳腺癌根治术的患者作为研究对象,按照麻醉方式不同分为观察组和对照组各60例,其中观察组患者给予胸神经阻滞复合全身麻醉,对照组患者给予肋间神经阻滞复合全身麻醉。比较两组患者术后2h、6h、12h、24h、48h的静态和动态的视觉模拟评分(VAS)评分,并比较两组患者切皮前5 min(T_0)、切皮即刻(T_1)、切皮后15 min(T_2)、30 min(T_3)、钉皮即刻(T_4)及拔管后15 min(T_5)的血流动力学以及呼吸功能指标,并分析两组患者术中用药、术后镇痛泵使用情况以及术后不良反应。结果:两组患者术后静息状态下不同时点的VAS评分差异无统计学意义(P0.05);动态状态下,观察组患者的VAS评分明显低于对照组(P0.05)。T_1-T_5期间,观察组患者的平均动脉压(MAP)、心率(HR)均明显低于对照组,每分钟通气量(MV)明显高于对照组(P0.05)。观察组患者的术中瑞芬太尼消耗量、丙泊酚用量、镇痛泵有效按压次数以及补救镇痛例数均明显低于对照组;恶心呕吐(PONV)、尿潴留、嗜睡等不良反应明显低于对照组(P0.05)。结论:与肋间神经阻滞相比,胸神经阻滞治疗乳腺癌根治术患者可以有效增强术后镇痛效果,术中血流动力学平稳,减少阿片类药物用量,降低术后不良反应发生率,改善术后呼吸功能,效果显著,值得临床推广使用。

A Comparative Study of Thoracic Nerve Block and Intercostal Nerve Block on Hemodynamics, Postoperative Analgesia and Respiratory Function in Patients Undergoing Radical Mastectomy

ABSTRACT Objective: To compare the effects of thoracic nerve block and intercostal nerve block on hemodynamics, postoperative analgesia and respiratory function in patients undergoing radical mastectomy, and to provide reference for clinical anesthesia selection in patients undergoing radical mastectomy. Methods: 120 patients who received radical mastectomy in our hospital from March 2017 to March 2018 were selected as subjects. They were divided into observation group and control group according to different anesthesia methods, 60 cases in each group. Among them, patients in the observation group were given thoracic nerve block combined with general anesthesia, and patients in the control group were given intercostal nerve block combined with general anesthesia. Compare two groups of patients with postoperative 2h, 6h, 12h, 24h, 48h of static and dynamic visual analogue scale (VAS) score, and compare the two groups of patients before cutting leather 5 min (T₀), cut skin instantly (T₁), 15 min after the cut leather (T₂), 30 min (T₃), nail skin instantly (T₄) and 15 min after the extubation(T₅) hemodynamics and respiratory function indicators, and analyze the two groups of patients with intraoperative medication, use of postoperative analgesia pump, and postoperative adverse reactions. Results: There was no statistically significant difference in VAS scores at different time points in postoperative resting state between the two groups (P>0.05). Under the dynamic state, the VAS score of the observation group was significantly lower than that of the control group (P<0.05). During T₁-T₅, the average arterial pressure (MAP) and heart rate (HR) in the observation group were significantly lower than those in the control group, and the air volume per minute (MV) was significantly higher than those in the control group (P<0.05). The intraoperative remifentanil consumption, propofol dosage, analgesic pump effective compression times, and remedial analgesia were significantly lower in the observation group than in the control group. Adverse reactions such as nausea and vomiting (PONV), urinary retention, and drowsiness were significantly lower than those in the control group (P<0.05). Conclusion: compared with intercostal nerve block, thoracic nerve block can effectively enhance postoperative analgesic effect, stabilize intraoperative hemodynamics, reduce the amount of opioid, reduce the incidence of adverse reactions, improve postoperative respiratory function, and is worthy of clinical application.