【摘要】 目的:研究超声引导下前锯肌平面阻滞(SAPB)及竖脊肌平面阻滞(ESPB)联合术后自控静脉镇痛(PCIA)在乳腺癌改良根治术围术期的应用。方法:选取150例乳腺癌改良根治术患者为研究对象,按照麻醉方法不同分为SAPB组、ESPB组和对照组,每组各50例。在常规全身麻醉基础上,SAPB组行前锯肌平面阻滞麻醉;ESPB组行竖脊肌平面阻滞麻醉;对照组不进行阻滞麻醉;术后三组患者均给予PCIA。比较三组患者术后2、4、8、12、24、48 h静息与咳嗽时视觉模拟评分(VAS)及Ramsay镇静评分、术中丙泊酚及瑞芬太尼用量、术后48 h PCIA镇痛按压次数、PCIA舒芬太尼用量、术后早期康复指标及不良反应。结果:术后2、4、8、12、24及48 h, SAPB组及ESPB组静息与咳嗽时VAS评分低于对照组(P<0.05);三组患者术后镇静Ramsay评分比较,差异无统计学意义(P>0.05);SAPB组及ESPB组术中丙泊酚和瑞芬太尼用量、术后48 hPCIA按压次数及PCIA舒芬太尼用量低于对照组(P<0.05);术后首次肛门排气时间、下床时间及术后住院时间短于对照组(P<0.05);三组患者呕吐发生率比较,差异无统计学意义(P>0.05);SAPB组及ESPB组皮肤瘙痒、恶心发生率低于对照组(P<0.05)。结论:超声引导下SAPB、ESPB联合术后PCIA在乳腺癌改良根治术的应用效果均较好,可有效预防术后疼痛及并发症的发生,值得推广应用。更多还原

【Abstract】 Objective:To study the perioperative application of ultrasound-guided Serratus anterior plane block(SAPB),erector spinal plane block(ESPB) combined with postoperative Controlled venous analgesia(PCIA) in modified radical mastectomy of breast cancer.Methods:150 patients with modified radical mastectomy for breast cancer were selected as research subjects.According to the anesthesia method, they were divided into SAPB group, ESPB group and control group, with 50 cases in each group.On the basis of routine general anesthesia, the SAPB group received serratus anterior plane block, and the ESPB group received erector spinal plane block, the control group was not given block anesthesia.Postoperative PCIA was given to the patients.The Visual analogue scale(VAS),Ramsay sedation score, intraoperative dosage of propofol and remifentanil, the number of PCIA analgesic compresses 48 h after surgery, the dosage of sufentanil in PCIA,early postoperative rehabilitation indexes and adverse reactions at rest and coughing at 2,4,8,12,24,48 h after operation in three groups were compared.Results: At 2,4,8,12,24 and 48 h after surgery, the VAS scores at rest and coughing of the SAPB group and ESPB group were lower than that of the control group(P<0.05).There was no significant difference in postoperative sedation Ramsay scores between SAPB group, ESPB group and control group(P>0.05).The dosage of propofol, remifentanil, PCIA press times 48 h after surgery and sufentanil for PCIA in SAPB and ESPB groups were significantly lower than those in control group(P<0.05).The first anal exhaust time, bed time and postoperative hospitalization time of SAPB and ESPB groups were significantly lower than those of control group(P<0.05).There was no significant difference in the incidence of vomiting among the three groups(P>0.05).The incidence of skin pruritus and nausea in SAPB and ESPB groups was significantly lower than that in control group(P<0.05).Conclusion: Ultrasound-guided SAPB,ESPB and postoperative PCIA have significant effects in improved radical mastectomy of breast cancer, which can effectively prevent the occurrence of postoperative pain and it complications and is worthy of promotion and application.更多还原