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超声引导下间隔平面胸椎旁阻滞联合TIVA应用于乳腺癌改良根治术对术后疼痛的影响

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Keywords: 胸椎旁阻滞,超声引导,术后疼痛

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Abstract:

目的评估超声引导下间隔平面胸椎旁阻滞联合全凭静脉麻醉(totalintravenousanesthesia,TIVA)用于乳腺癌改良根治术对术后疼痛的影响。方法60例行乳腺癌根治术18~85岁女性患者,ASAⅠ~Ⅲ级,按随机数字表法分为2组,每组30例。静吸复合组行静吸复合全身麻醉,胸椎旁阻滞组行多平面胸椎旁阻滞联合TIVA,术中自主呼吸。2组术后镇痛均采用患者自控静脉镇痛(patient-controlledintravenousanalgesia,PCIA)。在T1(入室时)、T2(手术开始前即刻)、T3(切皮后5min)、T4(腋窝清扫时)、T5(手术结束时)、T6(拔除喉罩时)、T7(转出PACU时)记录患者的心率、血压、脉搏氧饱和度(SpO2)、呼气末二氧化碳(PETCO2)和脑电双频谱指数(bispectralindex,BIS);在T8(术后2h)、T9(术后4h)、T10(术后8h)、T11(术后16h)、T12(术后24h)对患者进行VAS疼痛评分。记录术中舒芬太尼用量,PACU停留时间,PCIA舒芬太尼用量和PCIA按压次数及术后麻醉相关并发症情况。结果在手术开始前即刻,胸椎旁阻滞组心率明显高于静吸复合组,在手术结束时,胸椎旁阻滞组心率明显低于静吸复合组(P<0.05)。血压、SpO2、PETCO2和BIS在各时间点差异无统计学意义(P>0.05)。胸椎旁阻滞组在术后2、4h和术后8h平静休息和咳嗽时VAS评分均低于静吸复合组。胸椎旁阻滞组的术中舒芬太尼用量、PACU停留时间、PCIA舒芬太尼用量和按压次数均低于静吸复合组(P<0.05)。胸椎旁阻滞组术后麻醉相关并发症发生例数少于静吸复合组,但2组发生率差异无统计学意义(P>0.05)。结论超声引导下胸椎旁阻滞可安全有效的应用于乳腺癌改良根治术,不仅可以有效减少围术期阿片类药物的用量,降低PACU停留时间,而且能改善术后急性疼痛,有利于患者术后恢复。

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