| 陈祖涛,张立群,韩俊.不同神经阻滞方案对乳腺癌改良根治术后镇痛效果的影响[J].安徽医药,2021,25(1):104-107. |
| 不同神经阻滞方案对乳腺癌改良根治术后镇痛效果的影响 |
| Influence of different kinds of nerve block schemes onanalgesic effect after modified radical mastectomy for breast cancer |
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| DOI：10.3969/j.issn.1009?6469.2021.01.026. |
| 中文关键词: 乳房切除术，改良根治性 乳腺肿瘤 神经传导阻滞 胸神经 胸椎 疼痛，手术后 镇痛 |
| 英文关键词: Mastectomy,modified radical Breast neoplasms Nerve block Thoracic nerves Thoracic vertebrae Pain, postoperative Analgesia |
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| 中文摘要: |
| 目的探讨胸椎旁神经(TPVN)阻滞和胸神经 Ⅱ(Pectoral Nerves Ⅱ，Pecs Ⅱ)阻滞对乳腺癌改良根治术后镇痛及阻滞效果的影响。方法选取平煤神马医疗集团总医院 2016年 8月至 2019年 1月收治的乳腺癌病人共 130例，均行改良根治术治疗；入选病人以随机抽签法分为 TPVN组(65例)和 Pecs Ⅱ组(65例)，其中 TPVN组在超声引导下采用 TPVN阻滞，而 Pecs Ⅱ组则在超声引导下采用 Pecs Ⅱ阻滞；比较两组术后 VAS疼痛评分、 Ramsay镇静评分、镇痛效果持续时间、术后 24 h舒芬太尼使用量及局麻药物扩散区域。结果 Pecs Ⅱ组术后 2h、6h、12 h、24 h VAS疼痛评分分别为(0.52±0.10)分，(1.90±0.52)分，(3.21±0.94)分，(2.60±0.82)分，均显著低于 TPVN组为(0.94±0.22)分，(2.35±0.69)分，(3.94±1.22)分，(3.23±1.09)分(P＜0.05)；两组术后 Ramsay镇静评分组间比较差异无统计学意义(P＞0.05)； Pecs Ⅱ组镇痛效果持续时间和术后 24 h舒芬太尼使用量分别为(342.70±62.62)min，(6.96±1.02)μg，均显著优于 TPVN组的(215.96±46.17)min，(10.51±1.49)μg(P＜0.05)； Pecs Ⅱ组 T2扩散比例显著高于 TPVN组(P＜0.05)；同时两组 T3、T4、T5及 T6扩散比例组间比较差异无统计学意义(P＞0.05)。结论与 TPVN阻滞相比，行乳腺癌改良根治术病人采用 Pecs Ⅱ阻滞方案应能够有效减轻术后疼痛，增加镇痛效果持续时间，降低阿片类药物用量，并有助于获得更为完善阻滞效果。 |
| 英文摘要: |
| Objective To investigate the influence of TPVN and Pecs Ⅱ for nerve block schemes on analgesia and blocking ef?fect of patients after modified radical mastectomy.To explore the effects of thoracic paravertebral nerve(TPVN)block and thoracic nerve Ⅱ(Pectoral Nerves Ⅱ，Pecs Ⅱ)block on the analgesia and block effect after modified radical mastectomy for breast cancer. Methods A total of 130 patients with breast cancer admitted to General Hospital of Pingmei Shenma Medical Group from August2016 to January 2019 were chosen，and all of them were treated with modified radical mastectomy.The patients wererandomly divid? ed into TPVN group(65 patients)and Pecs Ⅱ group(65 patients)of which the TPVN group used TPVN block under ultrasound guidance，while the Pecs Ⅱ group used Pecs Ⅱ block under ultrasoun，d guidance.The VAS score and Ramsay sedation score after operation，duration of analgesia，the usage of sufentanil in 24 hours after operation and the diffusion region of local anesthetics of both groups were compared.Results The VAS scores of the Pecs Ⅱ group at 2 h，6h，12 h and 24 h after operation were(0.52±0.10)points，(1.90±0.52)points，(3.21±0.94)points，(2.60±0.82)points，which were significantly lower than those in the TPVN group:(0.94±0.22)points，(2.35±0.69)points，(3.94±1.22)points，(3.23±1.09)points(P＜0.05).There was no significant differ? ence in the Ramsay sedation score after operation between the two groups(P＞0.05).The duration of analgesic effect in the Pecs Ⅱ group and the amount of sufentanil used at 24 h after surgery were(342.70±62.62)min and(6.96±1.02)μg，respectively， which were significantly better than those in the TPVN group(215.96±46.17)min，(10.51±1.49)μg(P＜0.05)； The T2 diffusion ratio of the Pecs Ⅱ group was significantly higher than that of the TPVN group(P＜0.05)； at the same time，there was no signifi? cant difference in the T3，T4，T5 and T6 diffusion ratios between the two groups(P＞0.05).Conclusion Compared with TPVN， Pecs Ⅱ for ultrasound?guided nerve block schemes in the treatment of patients after radical mastectomy can efficiently relieve paindegree，prolong duration of analgesia，reduce opioid dosage and be helpful to achieve more perfect blockade. |
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