| 摘要: |
| 目的 观察超声引导胸神经阻滞在乳房肿块切除手术中的镇痛效果及安全性。方法 选择本院2017 年1 月至2018 年2 月期间行单侧乳房肿块切除手术的患者 60例,美国麻醉医师协会分级Ⅰ或Ⅱ级, 采用随机数字表法随机分为两组,超声引导神经阻滞组( nerve blocking, N 组)和局部麻醉组(local anesthesia, L 组) ,每组30 例 。超声引导神经阻滞组,行超声引导下胸神经阻滞,注射0.5%罗哌卡因20mL. 局部麻醉组,沿手术梭形切口逐层注射局麻药1%利多卡因20mL。记录两组患者入室时,切皮时,乳房肿块切除时,缝皮时的平均动脉血压( mean arterialblood pressure, MAP) 心率( heart rate, HR) 。记录两组患者术后 2、 4、 8、 12 h视觉模拟量表( visualanalogue scale scores, VAS) 评分。记录两组患者术中追加舒芬太尼的病例数和发生呼吸抑制,恶心,呕吐,神经损伤,局麻药中毒的病例数。结果: N 组患者术中生命体征较L组更加平稳( P ＜ 0. 05) 。N 组术后4、8、和12 h N 组较L 组明显降低( P ＜ 0. 05),两组术后2 h 两组患者 VAS 评分差异无统计学意义( P ＞ 0. 05)。N 组术中追加芬太尼的病例数明显少于L组( P ＜ 0. 05)两组均未出现神经损伤和局麻药中毒症状,两组患者术后呼吸抑制、恶心、呕吐的发生率的差异均无统计学意义( P ＞ 0. 05)。结论 超声引导下胸神经阻滞能够充分满足乳房肿块切除手术的麻醉要求,镇痛持续时间更长,更加安全有效。 |
| 关键词: 超声引导 胸神经 神经阻滞 乳房肿块 |
| DOI： |
| 投稿时间：2019-01-10修订日期：2019-08-14 |
| 基金项目:上海市浦东医院院级人才培养-浦菁计划项目(PJ201701) |
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| The effect of ultrasound-guided pectoral muscle block in mastectomy |
| ZHANG Nannan,xiepengcheng |
| (Department of Anesthesia,Shanghai Pudong Hospital,Fudan University Pudong Medical Center) |
| Abstract: |
| 【】Objective To observe the analgesic effect and safety of ultrasound-guided pectoral muscle block in mastectomy. Methods From January 2017 to January 2018, Sixty patients, American Society of Anesthesiologists(ASA)Ⅰ－Ⅱ, aged 28－59 years, scheduled for unilateral open inguinal herniorrhaphy were equally and randomly assigned to ultrasound-guided nerve block group (N group) or Local anesthesia group (Group L) using randomization table(n=30).. The patients in group N received ultrasound-guided unilateral paravertebral block with 20 mL 0.5% ropivacaine respectively. In the group L, along the surgical shuttle incision layer injection of local anesthetic 1% lidocaine 20mL. Heart rate (HR), and mean arterial pressure (MAP) were recorded at the time of entering the operating room ,skin incision ,removing breast lumps and skin suture. Visual analogue scale (VAS) scores at 2h, 4 h, 8 h,12 h after surgery were recorded. the number of cases of using sufentanil , respiratory depression, nausea, vomiting, nerve damage, and local anesthetic poisoning were recorded in both groups. Results The vital signs during the operation in the N group,were more stable than those in the L group (P < 0.05). VAS scores in the group N was significantly lower than the L group at 4, 8, and 12 h after operation (P < 0.05). There was no significant difference in VAS scores at 2 h after surgery between the two groups(P > 0.05). The number of fentanil in group N was significantly less than in group L (P < 0.05). There were neurological injury and local anesthetic poisoning symptoms. There was no significant difference in postoperative respiratory depression, nausea and vomiting between the two groups (P > 0.05). Conclusion Ultrasound-guided chest muscle nerve block can fully meet the breast Anesthesia for lumpectomy surgery requires longer analgesia and is safer and more effective. |
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