摘要
目的评价胸肋间筋膜阻滞(PIFB)-胸部神经Ⅱ型(PECSⅡ)阻滞-全身麻醉用于乳腺癌改良根治术的效果。方法选择择期行乳腺癌改良根治术患者46例,ASA分级Ⅰ或Ⅱ级,年龄40~65岁,采用随机数字表法分为2组(n=23):PECSⅡ阻滞-全身麻醉组(P+G组)和PIFB-PECSⅡ阻滞-全身麻醉组(P+P+G组)。患者于预麻间分别在超声引导下PECSⅡ阻滞(P+G组)和PIFB联合PECSⅡ阻滞(P+P+G组),随后入室,采用咪达唑仑、丙泊酚、舒芬太尼和顺式阿曲库铵行麻醉诱导,采用七氟烷、瑞芬太尼和顺式阿曲库铵行麻醉维持。记录术中瑞芬太尼用量、苏醒时间和气管拔管时间。术后采用静脉注射氟比洛芬酯50 mg补救镇痛,维持静态VAS评分≤3分。记录术后24 h内补救镇痛情况和恶心呕吐发生情况。结果与P+G组比较,P+P+G组术中瑞芬太尼用量减少,苏醒时间和拔除气管导管时间缩短,术后24 h内补救镇痛率降低,首次补救镇痛时间延长(P<0.05),恶心呕吐发生率差异无统计学意义(P>0.05)。结论相对于PECSⅡ阻滞-全身麻醉而言,PIFB-PECSⅡ阻滞-全身麻醉用于乳腺癌改良根治术,可减少术中阿片类药物用量,抑制术后痛敏反应,促进术后早期恢复。
Objective To evaluate the efficacy of pecto-intercostal fascial block(PIFB)-pectoral nerve block typeⅡ(PECSⅡblock)-general anesthesia for modified radical mastectomy.Methods Forty-six patients,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,aged 40-65 yr,scheduled for elective modified radical mastectomy,were divided into 2 groups(n=23 each)using a random number table method:PECSⅡblock-general anesthesia group(group P+G)and PIFB-PECSⅡblock-general anesthesia group(group P+P+G).The patients received ultrasound-guided PECSⅡblock(P+G group)or PIFB combined with PECSⅡblock(P+P+G group)in the pre-anesthesia room.Then the patients were admitted to the operating room,and midazolam,propofol,sufentanil and cisatracurium were used for anesthesia induction,and sevoflurane,remifentanil and cisatracurium were used for anesthesia maintenance.The intraoperative consumption of remifentanil,emergence time and extubation time were recorded.Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation,and visual analog scale score was maintained≤3 at rest.The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group P+G,the intraoperative consumption of remifentanil was significantly decreased,the emergence time and extubation time were shortened,the rate of rescue analgesia within 24 h after operation was decreased,the time of first rescue analgesia was prolonged(P<0.05),and no significant change was found in the incidence of nausea and vomiting in group P+P+G(P>0.05).Conclusions Compared with PECSⅡblock-general anesthesia,PIFB-PECSⅡblock-general anesthesia can reduce the amount of intraoperative opioids,inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.
作者
杨大威
王瑶
张建友
马蓉蓉
Yang Dawei;Wang Yao;Zhang Jianyou;Ma Rongrong(Department of Anesthesiology,Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2023年第7期823-826,共4页
Chinese Journal of Anesthesiology
