【摘要】 目的：评估无阿片药麻醉在乳腺癌改良根治术中的应用效果。方法：将80例择期行单侧乳腺癌改良根治术的患者随机分为两组：全麻组（G组）和无阿片药麻醉组（O组）。G组采用阿片类药物喉罩全麻，O组采用静脉注射利多卡因联合胸椎旁神经阻滞喉罩全麻。观测指标包括入室时（T₀）、诱导时（T₁）、手术开始时（T₂）、腺体切除时（T₃）、入复苏室时（T₄）的平均动脉压（MAP）和心率（HR）；手术时间、苏醒时间、排气时间和下床时间；术后2 h（T₅）、6 h（T₆）、12 h（T₇）的VAS评分和术前（T₈）、术后6 h（T₉）、术后12 h(T₁₀)的全身免疫炎症指数（SII）；术后恶心呕吐（PONV）及乳腺癌术后疼痛综合征（PMPS）的发生情况;不良事件的发生情况等。结果：O组患者术中的MAP和HR较G组更平稳（P<0.05）;O组苏醒时间、排气时间、下床时间均早于G组（P<0.05）；术后VAS、SII数值均明显低于G组（P<0.05）;PONV的发生率也显著降低（P<0.05）;O组患者未发生气胸、血肿、局麻药中毒等不良事件。结论：无阿片药麻醉在乳腺癌改良根治术中安全有效，能够缩短苏醒时间、排气时间和下床时间，减轻术后疼痛和全身炎症反应，降低围术期循环波动，减少术后恶心呕吐的发生率。更多还原

【Abstract】 Objective:This study aimed to evaluate the application effect of opioid-free anesthesia（OFA） in modified radical mastectomy for breast cancer.Methods:80 patients undergoing unilateral modified radical mastectomy were randomly divided into two groups:general anesthesia group（G group） and OFA group（O group）.The G group received general anesthesia with opioid drugs and a laryngeal mask,while the O group received general anesthesia with intravenous lidocaine combined with thoracic paravertebral nerve block and a laryngeal mask.The average arterial pressure （MAP） and heart rate（HR） of the patients were recorded at the time of admission（T₀）,induction（T₁）,start of surgery（T₂）,gland resection（T₃）,and admission to the recovery room（T₄）.The surgical time,awakening time,extubation time,and getting out of bed time were recorded.The VAS score at 2 hours（T₅）,6 hours（T₆）,and 12 hours（T₇）after surgery,as well as the systemic immune-inflammatory index（SII） before surgery（T₈）,6 hours after surgery（T₉）,and 12 hours after surgery(T₁₀) were recorded.The occurrence of postoperative nausea and vomiting（PONV） and postmastectomy pain syndrome（PMPS） were recorded.The occurrence of adverse events such as poor nerve block effect,pneumothorax,hematoma,and local anesthetic toxicity were also recorded.Results:The MAP and HR of the O group were more stable than those of the G group during surgery（P<0.05）.The awakening time,extubation time,and getting out of bed time in the O group were earlier than those in the G group（P<0.05）.The VAS and SII values after surgery were significantly lower in the O group than in the G group（P<0.05）.The incidence of PONV was also significantly decreased（P<0.05）.In addition,no adverse events such as pneumothorax,hematoma,or local anesthetic toxicity occurred in the O group.Conclusion:Pioid-free anesthesia is safe and effective in modified radical mastectomy for breast cancer,shortening recovery time,time to first flatus,and time to ambulation,while alleviating postoperative pain,systemic inflammatory response,perioperative hemodynamic fluctuations,and the incidence of postoperative nausea and vomiting.更多还原