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第44卷第5期 吴春培,孙正霞,刘 辉,等. 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[J].
2024年5月 南京医科大学学报(自然科学版),2024,44(5):666-671 ·669 ·
表2 两组患者不同时间点SBP、DBP和HR的比较
Table 2 Comparison of SBP,DBP,HR at different time points between the two groups of patients (x ± s)
Indicator Group T0 T1 T2 T3 T4 F P
SBP(mmHg) GA(n=30) 130.0 ± 11.6 099.4 ± 7.2 a 123.5 ± 7.1 a 124.5 ± 9.0 a 111.4 ± 11.2 a 63.718 <0.001
TO(n=30) 132.9 ± 13.7 102.5 ± 8.6 a 126.3 ± 14.1 a 127.2 ± 15.5 a 110.7 ± 13.3 a 48.090 <0.001
t -0.884 -1.529 -0.963 -0.822 -0.220
P -0.380 -0.132 -0.340 -0.414 -0.826
DBP(mmHg) GA(n=30) 77.1 ± 6.8 060.7 ± 4.9 a 069.5 ± 5.6 a 073.6 ± 6.6 a 068.7 ± 7.2 a 40.076 <0.001
TO(n=30) 78.3 ± 7.1 063.1 ± 6.3 a 071.2 ± 8.7 a 075.3 ± 9.0 a 066.5 ± 7.7 a 33.976 <0.001
t -0.668 -1.653 -0.886 -0.816 -1.104
P -0.507 -0.104 -0.379 -0.418 -0.274
HR(beats/min) GA(n=30) 77.5 ± 7.5 060.7 ± 6.2 a 072.1 ± 7.3 a 071.1 ± 8.0 a 067.0 ± 6.4 a 43.203 <0.001
TO(n=30) 79.4 ± 7.6 063.6 ± 5.6 a 073.5 ± 6.2 a 073.8 ± 7.4 a 069.9 ± 5.6 a 34.587 <0.001
t -0.980 -1.864 -0.804 -1.354 -1.845
P -0.331 -0.067 -0.425 -0.181 -0.070
a
Compared with T0,P < 0.05.
表3 两组患者不同时点安静、运动状态VAS评分的比较
Table 3 Comparison of NRS scores at rest and during movement at different time points between the two groups of patients
(x ± s)
Variable Group Postoperative 2 h Postoperative 6 h Postoperative12 h Postoperative 24 h Postoperative 48 h
VAS at rest GA(n=30) 2.4 ± 0.5 a 2.8 ± 0.7 a 2.9 ± 0.7 2.5 ± 0.5 2.0 ± 0.4
TO(n=30) 2.0 ± 0.2 a 2.4 ± 0.5 a 2.4 ± 0.5 2.2 ± 0.4 1.9 ± 0.3
t 3.491 2.862 <2.675 1.921 1.439
P 0.001 0.009 <0.010 0.060 0.155
VAS during movement GA(n=30) 2.9 ± 0.6 a 3.6 ± 0.9 a 3.7 ± 1.0 3.0 ± 0.7 2.5 ± 0.6
TO(n=30) 2.5 ± 0.6 a 2.7 ± 0.8 a 2.8 ± 0.7 2.7 ± 0.6 2.3 ± 0.5
t 2.373 3.517 <4.019 1.942 0.793
P 0.021 0.001 <0.001 0.057 0.431
表4 两组患者术后24 h QoR⁃40 评分的比较
Table 4 Comparison of QoR⁃40 scores 24 h postoperatively between the two groups of patients[M(P25,P75)]
Group Total scores Emotional state physical comfort
GA(n=30) 183.50(176.00,188.25) 41.00(40.00,43.00) 54.00(51.75,55.25)
TO(n=30) 189.00(185.50,192.00) 43.00(42.00,43.25) 56.00(54.00,57.00)
Z -3.179 -2.735 -3.347
P -0.001 -0.006 -0.001
Group Physical independence Psychological support Pain
GA(n=30) 24.00(23.00,24.25) 31.50(31.00,33.25) 32.00(30.00,33.00)
TO(n=30) 24.00(24.00,25.00) 34.00(31.75,34.00) 33.00(32.00,34.00)
Z -1.848 -2.722 -3.069
P -0.065 -0.006 -0.002
[6]
共识指出了围术期区域神经阻滞联合低剂量阿片 促进患者术后早期恢复 。羟考酮能同时激动μ、κ
全麻和多模式镇痛的重要性 。最新的国外乳房整 受体,对切口痛和内脏痛均具有良好的镇痛作用,
[5]
形手术ERAS指南更新亦证实术中联合区域神经阻 多项研究证实羟考酮能提供优于舒芬太尼的镇痛
[7]
滞,术后多模式、少阿片药物疼痛管理方案能显著 效果,且患者苏醒快 ,恶心呕吐、皮肤瘙痒 [8-9] 、免
减轻疼痛,降低阿片类药物消耗量,缩短住院时间, 疫抑制 [2,10] 和术后认知功能障碍 [11] 等不良反应发生