摘要
目的评价喉罩全身麻醉复合超声引导下胸椎旁神经阻滞在乳腺癌根治术的麻醉及术后镇痛方面的效果。方法选择接受乳腺癌根治术的患者30例,均为女性,年龄47~78岁,体重57~78 kg,美国麻醉医师学会分级Ⅰ~Ⅲ级,随机分为2组,每组15例。A组行常规气管插管静吸复合全身麻醉,B组在超声引导下实施胸椎旁神经阻滞后行喉罩全身麻醉,术中患者自主呼吸。两组术后镇痛均应用患者自控静脉镇痛（PCIA）。在两组气管插管和插入喉罩即刻,手术切皮即刻,以及手术开始后20、40、60和80 min时,记录心率（HR）、平均动脉压（MAP）和脉搏血氧饱和度（SpO2）。记录入麻醉恢复室（PACU）后10、20和30 min的HR、MAP、SpO2。记录术后2、4、6、8和24 h的疼痛视觉模拟（VAS）评分。记录48 h PCIA的用药总量、有效按压次数及术后恶心呕吐（PONV）和咽喉疼痛的发生情况。结果在气管插管和切皮即刻,手术20、40和60 min,以及PACU中10、20和30 min时,A组的HR均显著快于B组（P值分别〈0.01、0.05）,MAP均显著高于B组（P值均〈0.01）。两组在各观察时间点SpO2的差异均无统计学意义（P值均〉0.05）。A组在术中的芬太尼使用总量、气管插管后芬太尼追加剂量、术后48 h PCIA的用药总量和PCIA有效按压次数均显著高于B组（P值均〈0.01）。A组术后2、4、6、8、24 h的疼痛VAS评分均显著高于B组（P值均〈0.01）。A组的PONV和咽喉疼痛的发生率分别为9/15和5/15,均显著高于B组的2/15和1/15（P值均〈0.01）。结论喉罩全身麻醉复合超声引导下胸椎旁神经阻滞可以安全有效地应用于乳腺癌根治术,其生理干扰轻微并能提供良好的术后镇痛效果,并发症少。
Objective To evaluate the efficacy of laryngeal mask anesthesia（LMA） combined with ultrasound-guided thoracic paravertebal block（TPVB） for anesthesia and postoperative analgesia of radical mastectomy.Methods Thirty American Society of Anesthesiologists（ASA） Ⅰto Ⅲ patients,aged 47-78 years,weighing 57-78 kg,undergoing radical mastectomy,were randomized into 2 groups（n=15 each）： group A and group B.Group A was given traditional intravenous-inhalation anesthesia combined with endotracheal intubation（ETT）.Group B received thoracic paravertebal block（TPVB） guided by ultrasound and laryngeal mask general anesthesia;the patients also had spontaneous breath.Two groups received patient controlled intravenous analgesia（PCIA） after operation.We recorded the heart rate（HR）,mean artery pressure（MAP）,and saturation pulse oxygen（SpO2） of two groups on ETT/LMA insertion,cutting skin and 20,40,60,80 min of operation and 10,20,30 min in post-anesthesia care unit（PACU）.We also recorded the dosage of fentanyl and supplement dosage of fentanyl after intubation.The pain visual analog scale（VAS） scores 2,4,6,8,24 h after operation,dosage of 48 h PCIA,frequencies of PCIA effective pressing,and incidences of post-operative nausea and vomiting（PONV） and pharyngalgia were also observed.Results HR of group A was significantly faster than those of group B on ETT/LMA insertion,cutting skin and 20,40,60,80 min of operation and 10,20,30 min in PACU（P0.01,0.05）;MAP of group A were significantly higher than those of group B（P0.01）.SpO2 were similar between two groups during operation or in PACU（P0.05）.The dosage of fentanyl,supplement dosage of fentanyl after intubation and the dosage of 48 h PCIA,and frequencies of PCIA effective pressing in group A were significantly more than those in group B（P0.01）.VAS scores in group A were significantly higher than those in group B on postoperative 2,4,6,8,24 h（P0.01）.The incidences of PONV and pharyngalgia in group A（9/15 and 5/15,respectively） were all significantly higher than those in group B（2/15 and 1/15,P0.01）.Conclusion Laryngeal mask anesthesia combined with ultrasound-guided thoracic paravertebal block is safe and effective for radical mastectomy,with satisfactory postoperative analgesic effect and less complications.
出处
《上海医学》
CAS
CSCD
北大核心
2011年第6期424-427,共4页
Shanghai Medical Journal
关键词
超声引导
胸椎旁神经阻滞
喉罩
术后镇痛
Ultrasound-guided
Throracic paravertebal block
Laryngeal mask
Postoperative analgesia
