摘要
目的比较不同浓度罗哌卡因切口持续浸润对乳腺癌患者术后镇痛的效果,以期筛选提高乳腺癌患者术后镇痛的最佳方法。方法选择行乳腺癌根治术的患者156例作为研究对象,根据手术顺序编号,采用随机数字表法随机分为A、B、C 3组,每组52例,所有患者均由同一组医护人员行乳腺癌根治术。A组患者术后采用0.2%浓度罗哌卡因持续浸润手术切口,B组患者采用0.3%浓度罗哌卡因持续浸润手术切口,C组患者采用0.4%浓度罗哌卡因持续浸润手术切口,比较3组患者术后12、24、48、72 h视觉模拟评分(VAS),术后12、24、48 h血清前列腺素(PG)、一氧化氮(NO)、5-羟色胺(5-HT)、神经肽Y(NPY)、β-内啡肽(β-EP)水平。结果术后12、24、48、72 h,B、C组患者VAS评分均低于A组患者,差异均有统计学意义(P﹤0.05),C组患者VAS评分略低于B组患者,但两组比较差异均无统计学意义(P﹥0.05)。3组患者术前PG、NO、5-HT、NPY、β-EP水平比较,差异均无统计学意义(P﹥0.05);3组患者术后12、24、48 h血清PG水平均低于术前,血清NO、5-HT、NPY、β-EP水平均高于术前,差异均有统计学意义(P﹤0.05)。C组患者术后12、24、48 h PG水平均高于A组、B组,NO、5-HT、NPY、β-EP水平均低于A组、B组;B组患者术后12、24、48 h PG水平均高于A组,NO、5-HT、NPY、β-EP水平均低于A组,差异均有统计学意义(P﹤0.05)。结论浓度0.4%的罗哌卡因对乳腺癌根治术患者术后镇痛的效果更为明显,可能由于患者对VAS测试的主观性较强,与0.3%浓度比较VAS评分的差异未能体现,需进一步制定合理研究方案进行验证。
Objective To compare the postoperative analgesic effect of incision infiltration with different concentrations of ropivacaine in breast cancer patients after surgery, so as to determine the optimal strategy to improve postoperative analgesia. Method 156 patients who underwent radical mastectomy were randomized into group A, B or C according to the sequence of surgery, with 52 cases in each group. All patients were treated with radical mastectomy by the same medical staff. Patients in group A were treated with 0.2% ropivacaine for incision infiltration, and in group B were with0.3% ropivacaine, while in group C were with 0.4% ropivacaine. Visual analogue score（VAS） at 12, 24, 48 and 72 hours after surgery and serum levels of prostaglandin（PG）, nitric oxide（NO）, 5-hydroxytryptamine（5-HT）, neuropeptide Y（NPY）, β-endorphin（β-EP） levels at 12, 24 and 48 hours after surgery were compared among the three groups. Result The VAS scores of group B and group C were lower than those of group A at 12, 24, 48 and 72 hours after surgery（P〈0.05）. The VAS scores of group C were slightly lower than those of group B, but there was no significant difference between the two groups（P〉0.05）. The levels of PG, NO, 5-HT, NPY and β-EP were not significantly different among the three groups before surgery（P〉0.05）, but the levels of serum PG at 12, 24 and 48 hours after surgery were significantly decreased in the three groups, though the levels of serum NO, 5-HT, NPY and β-EP were significantly higher than those before surgery（P〈0.05）. The levels of PG in group C were higher than those in group A and group B at 12, 24 and 48 hours after surgery, and the levels of NO, 5-HT, NPY and β-EP were lower than those in group A and group B. The levels of PG in group B were higher than those in group A at 12, 24 and 48 hours after surgery, and the levels of NO, 5-HT,NPY and β-EP were lower than those in group A（P〈0.05）. Conclusion Ropivacaine at 0.4% concentration is more effective for postoperative analgesia in patients undergoing radical mastectomy. The difference of VAS score observed in ropivacaine with concentration at 0.3% to 0.4% may not be reflected, which is possibly due to the strong subjectivity of VAS test. A reasonable experimental scheme should be further developed to verify the effect.
作者
朱勤
王焱
柏明荣
李海英
ZHU Qin;WANG Yan;BO Mingrong;LI Haiying(Department of Anesthesiology,Bazhong Central Hospital,Bazhong 636000,Sichuan,China)
出处
《癌症进展》
2018年第10期1268-1271,共4页
Oncology Progress
关键词
乳腺癌根治术
罗哌卡因
切口持续浸润
术后镇痛
浓度筛选
radical mastectomy
ropivacaine
continuous infiltration of incision
postoperative analgesia
concentration screening
