超声引导下竖脊肌平面阻滞和胸椎旁阻滞对行乳腺癌根治术患者术后恢复的影响-东南大学学报医学版

超声引导下竖脊肌平面阻滞和胸椎旁阻滞对行乳腺癌根治术患者术后恢复的影响

单位：东南大学附属中大医院江北院区麻醉科, 江苏南京 210044

分类号：R737.9;R614.4

出版年·卷·期（页码）：2020·39·第四期（440-444）

摘要：

目的：探讨超声引导下竖脊肌平面阻滞（ESPB）与胸椎旁阻滞（TPVB）对行乳腺癌根治术患者术后镇痛及术后恢复的影响。方法：选取我院行择期乳腺癌根治术患者60例随机分为TPVB组（T组）和ESPB组（E组）。麻醉诱导前对两组患者行神经阻滞，两组术后均使用静脉自控镇痛泵（PCIA）。记录两组手术时间和神经阻滞操作时间，术后2、4、8、12、24、48 h静息和活动时患者疼痛视觉模拟（VAS）评分，术后48 h自控镇痛的次数、补救镇痛的次数以及镇痛满意度评分，术后首次肛门排气时间、首次下床活动时间和术后住院时间，两组术后的不良反应。结果：E组神经阻滞的操作时间显著短于T组（P<0.05）；两组术后VAS评分比较差异无统计学意义（P>0.05），术后48 h按压镇痛泵的次数、补救镇痛的次数和术后镇痛满意度比较差异无统计学意义（P>0.05），术后首次肛门排气时间、首次下床活动时间和术后住院时间比较差异无统计学意义（P>0.05），术后恶心呕吐的发生率差异无统计学意义（P>0.05）。结论：超声引导下ESPB对行乳腺癌根治术患者术后镇痛效果与TPVB无差异，但操作时间更短。

Objective: To investigate the effects of ultrasound-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) on postoperative recovery in patients undergoing radical mastectomy. Methods: Sixty patients with radical mastectomy were randomly divided into the TPVB group (T group) and the ESPB group (E group). Nerve block was performed in patients of both groups before induction of anesthesia, and patients in both groups were treated with intravenous patient controlled intravenous analgesia (PCIA). The operation time and nerve block operating time were recorded. The static visual analogue scale (VAS) scores and VAS scores at the time of cough were recorded at 2, 4, 8, 12, 24, 48 h after surgery. The number of pressing PCIA, remedial analgesia and the analgesic satisfaction score were recorded 48 h after surgery. The times of first anal exhaust, ambulation and hospitalization were recorded. The postoperative adverse reactions were also recorded. Results: The operation time of nerve block in E group was significantly shorter than that in T group (P<0.05). There was no significant difference in postoperative VAS score between the two groups(P>0.05). The number of pressing PCIA, remedial analgesia and the analgesic satisfaction score 48 h after surgery showed no significant differences in the two groups (P>0.05). There was no significant difference between the two groups in the times of first anal exhaust, ambulation and hospitalization (P>0.05). And there was no significant difference in the incidence of postoperative nausea and vomiting between the two groups (P>0.05). Conclusion: Ultrasound-guided ESPB has the same effect as TPVB in postoperative recovery of patients with radical mastectomy, but with shorter nerve block operating time.

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