| 赵杰.胸神经阻滞和胸横肌平面阻滞联合全身麻醉在乳腺癌患者术后镇痛效果的评估[J].浙江中西医结合杂志,2019,29(10): |
| 胸神经阻滞和胸横肌平面阻滞联合全身麻醉在乳腺癌患者术后镇痛效果的评估 |
| Evaluation of pectoral nerves block and transversus thoracic muscle plane block combined with general anesthesia for postoperative analgesia in patients undergoing radical mastectomy |
| 投稿时间：2018-12-28 修订日期：2019-03-28 |
| DOI： |
| 中文关键词: 胸神经阻滞 胸横肌平面阻滞 全身麻醉 乳腺癌 |
| 英文关键词:pectoral nerves block transversus thoracic muscle plane block general anesthesia radical mastectomy |
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| 中文摘要: |
| 【摘要】目的：评价超声引导胸神经（PECS）阻滞和胸横肌平面（TTP）阻滞联合全身麻醉对乳腺癌患者术后镇痛的效果。方法：选择进行单侧、原发性改良根治性乳房切除择期手术的女性105例，年龄18 ～ 64 岁，BMI20～27 kg∕m2，ASAⅠ或Ⅱ级。患者被随机分为三组(n=35)：全麻组（GA组）；全麻联合PECS阻滞组（CGA组）；全麻联合PECS和TTP组（PTGA组）。麻醉诱导结束后，CGA组与PTGA组分别进行超声引导下胸神经阻滞和胸横肌平面阻滞复合胸神经阻滞。在手术结束时，静脉注射帕瑞昔布钠40mg。记录术后12、24小时评估静息状态下和肩部外展时的VAS疼痛评分，记录补救镇痛率和恶心呕吐发生率，并通过针刺测试来评估T2-6水平胸部皮肤感觉缺失情况。结果：与GA组相比，CGA组和PTGA组在术后12、24小时评估静息状态下和肩部外展时的VAS疼痛评分降低，补救镇痛率和恶心呕吐发生率减少，在术后行针刺测试时T2-6水平的胸部外侧皮肤感觉缺失的患者人数增多，差异具有统计学意义（P<0.05）；与CGA组相比，PTGA组在术后12、24小时评估静息状态下和肩部外展时的VAS疼痛评分和补救镇痛率降低，恶心呕吐发生率和在术后行针刺测试时T2-6水平的胸部外侧皮肤感觉缺失患者人数无统计学差异（P>0.05），在术后行针刺测试时T2-6水平的胸部内侧皮肤感觉缺失患者人数明显增加（P<0.05）。结论： 相较于单纯全麻而言，全麻复合神经阻滞可以减少患者术后疼痛及恶心呕吐的发生率，但与PECS阻滞联合全身麻醉相比较，PECS阻滞和TTP阻滞联合全身麻醉对于乳腺癌手术患者的术后镇痛更完善。 |
| 英文摘要: |
| 【Abstract】 Objective :To evaluate the effect of pectoral nerves block(PECS) and transversus thoracic muscle plane block(TTP) combined with general anesthesia for postoperative analgesia in patients undergoing radical mastectomy. Methods:A total of 105 patients with elective, unilateral, primary modified radical mastectomy surgery,aged 18-64 yr，with body mass index 20～27 kg∕m2，of ASA physical status I and II;The patients were randomly allocated to one of three groups(n=35): general anesthesia group(group GA),only the PECS block combined with general anesthesia group(group CGA),PECS and TTP blocks combined with general anesthesia group(group PTGA). After induction of anaesthesia, ultrasound-guided nerve blocks were performed. In group CGA, only the PECS block was performed ,in group PTGA, PECS and TTP blocks were performed.At the end of the surgery, Parecoxib 40 mg was infused i.v.The VAS pain score was obtained at 12,and 24 h after surgery at rest. In addition, it was obtained at 12 and 24 h after surgery, during abduction of the shoulder. The sensory level was assessed using a pin-prick test. The requirement for rescue analgesia and development of nausea and vomiting were recorded. Results: Compared with group GA,the VAS pain scores of the CGA group and PTGA group were lower at all time points both at rest and during movement. The requirement for rescue analgesia and development of nausea and vomiting were decreased, and CGA group and PTGA group had a more effective sensory loss than the GA group in the region of the lateral cutaneous branches of the intercostal nerves (Th2-6)(P<0.05). Compared with group CGA, the VAS pain scores PTGA group was lower at all time points both at rest and during movement. The requirement for rescue analgesia was decreased(P<0.05).There was no significant difference between the two groups in the development of nausea and vomiting and in the sensory loss of the lateral cutaneous branches of the intercostal nerves (Th2-6)(P>0.05),whereas the PTGA group had a more effective sensory loss than the CGA group in the region of the anterior branches of the intercostal nerves (Th2-6). Discussion:Compared with general anesthesia alone, general anesthesia consistent with nerve block can reduce the incidence of postoperative pain and nausea and vomiting in patients. However, compared with PECS block combined with general anesthesia, PECS block and TTP block combined with general anesthesia are more effective and perfect for postoperative analgesia in breast cancer surgery. |
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