全身麻醉下胸横肌平面-胸神经阻滞在乳腺癌手术患者中的价值
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江苏省肿瘤医院

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江苏省卫生健康委干部保健科研项目(BJ20028)


Application value of transversus thoracic muscle plane-pectoral nerves block under general anesthesia in patients with breast cancer
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    摘要:

    【摘要】 目的: 评价胸横肌平面-胸神经(transversus thoracic muscle plane - pectoral? nerves,TTP-PECS)阻滞用于减阿片类药物全麻下乳腺癌改良根治术中的安全性与可行性。方法: 选择ASA I或II级,年龄34~64岁,体重45~73 Kg,择期行乳腺癌改良根治术的患者60例,随机分为胸横肌平面-胸神经阻滞联合减阿片药物全麻组(TO组)和常规全身麻醉组(GA组),每组30例。观察并记录两组患者各时点SBP、DBP、HR;各时点安静及运动状态VAS评分;术后24小时40项恢复质量评分量表(Quality of Recovery-40, QoR‐40)评分;围术期不良反应的发生率。结果: 与T0比较,两组患者T1~T4时点SBP、DBP、HR均显著降低 (P<0.05),但两组之间各时点SBP、DBP、HR比较差异无统计学意义(P>0.05);TO组术后2h、6h、12h安静及运动状态下VAS评分均显著低于GA组(P<0.05);TO组术后24h QoR‐40量表总评分及情绪状态、身体舒适度、心理支持、疼痛各项评分均显著高于GA组(P<0.05);TO组患者诱导期咳嗽反射及术后恶心呕吐的发生率显著低于GA组(P<0.05)。结论 胸横肌平面-胸神经阻滞联合羟考酮-丙泊酚减阿片药物全身麻醉可安全地用于乳腺癌改良根治术中,术后镇痛效果确切,降低术后恶心呕吐发生率,并能提高患者早期恢复质量。

    Abstract:

    [Abstract] Objective: To evaluate the safety and feasibility of transversus thoracic muscle plane - pectoral nerves?(TTP-PECS) block in??patients undergoing?modified radical mastectomy under opioid-sparing general anesthesia. Methods: Sixty patients of ASA I or II, aged 34-64 years, weighing 45-73 Kg, scheduled for modified radical mastectomy,were randomly divided into the TTP-PECS block combined with opioid-sparing general anesthesia group (group TO ) and the conventional general anesthesia group ( group GA ),with 30 cases in each group. The SBP, DBP, HR and VAS scores at rest and during movement at different time points of patients in both group were recorded, the QoR-40 scores were assessed at 24 hours after surgery, and the incidence of perioperative adverse reactions in both groups were also observed. Results: Compared with T0 , the SBP, DBP, and HR at time points T1 to T4 were significant decreased(P<0.05), but there were no obviously difference between the group TO and group GA(P>0.05). The VAS scores for both resting and movement pain at 2h, 6h, and 12h after surgery in the group TO were significantly lower than those in the group GA (P<0.05). The total score of the QoR-40 scale at 24h after surgery, as well as the scores for emotional state, physical comfort, psychological support, and pain, were all significantly higher in the group TO than those in the group GA (P<0.05). The incidence of cough reflex during induction and postoperative nausea and vomiting were significantly lower in the group TO than those in the group GA (P<0.05). Conclusions: The combination of? TTP - PECS block and oxycodone - propofol opioid-sparing general anesthesia is a safe and effective approach?for?patients?undergoing?modified radical mastectomy. This anesthesia technique?can provide?enhanced?postoperative?pain?relief and decrease the incidence of postoperative nausea and vomiting, therefore, it can improve the early recovery quality of patients with breast?cancer.

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  • 收稿日期:2023-12-24
  • 最后修改日期:2024-01-21
  • 录用日期:2024-04-19
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