Clinical effect of erector spinal plane block combined with opiate-free general anesthesia in breast cancer surgery
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摘要:目的
观察竖脊肌平面阻滞(ESPB)联合无阿片药全身麻醉对乳腺癌手术的临床效果。
方法选取择期行单侧乳腺癌手术的女性患者60例为研究对象, 年龄20~65岁, 美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级, 按密封信封法随机分为E组(ESPB联合无阿片药全身麻醉, n=30)和C组(单纯阿片药全身麻醉, n=30)。记录2组患者入室时(T0)、麻醉诱导后(T1)、置入喉罩后(T2)、切皮时(T3)、术中1 h(T4)及拔除喉罩后(T5)的平均动脉压(MAP)和心率(HR), 记录2组患者入PACU以及术后2、6、12、24、48 h各时点静息与活动时的疼痛视觉模拟评分法(VAS)评分和术后48 h内补救镇痛情况; 观察和记录2组患者术后拔管时间、PACU停留时间、首次肛门排气和下床活动时间及术后48 h内的不良反应发生情况。
结果与T0比较, C组T1~T4时点的MAP和HR均降低, 差异有统计学意义(P < 0.05); 与T0比较, E组T1~T4时点的MAP降低, T1~T5时点的HR均降低, 差异有统计学意义(P < 0.05)。与C组比较, E组T1时点MAP较高, T4时点HR较低, 差异有统计学意义(P < 0.05)。C组和E组术中低血压分别有12例(41.4%)和4例(14.3%), E组低血压占比低于C组, 差异有统计学意义(P < 0.05)。与C组比较, E组入PACU时和术后2 h的静息VAS评分较低, 入PACU时活动VAS评分也较低, 差异有统计学意义(P < 0.05)。E组PACU停留时间和首次肛门排气时间短于C组, 差异有统计学意义(P < 0.05)。术后48 h内, 2组未见明显心动过缓情况发生。E组术后48 h内总不良反应发生率低于C组, 尤其是术后恶心、呕吐的发生率低于C组, 差异有统计学意义(P < 0.05)。
结论ESPB联合无阿片药全身麻醉用于乳腺癌手术的临床效果满意, 并发症少, 有利于患者术后快速康复。
Abstract:ObjectiveTo observe clinical effect of erector spinae plane block (ESPB) combined with opioid-free general anesthesia in patients undergoing breast cancer surgery.
MethodsA total of 60 female patients aged 20 to 65 years and American Society of Association (ASA) type of class Ⅰ to Ⅱ undergoing unilateral breast cancer surgery were selected as study objects, and were randomly divided into group E(ESPB combined with opioid-free general anesthesia) and group C (opioid-free general anesthesia), with 30 cases in each group. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0), after anesthesia induction (T1), after laryngeal mask implantation (T2), after skin incision (T3), 1 h after operation (T4) and at the end of surgery (T5). Visual analogue scale (VAS) scores at rest and activity and analgesia within 48 h after surgery were recorded at PACU, postoperative 2 h, 6 h, 12 h, 24 h and 48 h. Postoperative extubation time, PACU residence time, first anal exhaust and ambulation time, and the occurrence of adverse reactions within 48 h after surgery were observed and recorded in two groups.
ResultsCompared with T0, MAP and HR were all lower at T1 to T4 in group C (P < 0.05). Compared withT0, MAP at T1 to T4 and HR at T1 to T5 in group E were decreased, and the differences were statistically significant (P < 0.05). Compared with group C, group E had a higher MAP at T1 and a lower HR at T4, and the difference was statistically significant (P < 0.05). There were 12 (41.4%) and 4 (14.3%) cases of intraoperative hypotension in group C and group E, respectively. The proportion of hypotension in the group E was lower than that in group C (P < 0.05). Compared group C, the VAS scores entering PACU and within postoperative 2 h were lower, and VAS score at activity entering PACU was lower(P < 0.05). PACU residence time and first anal exhaust time in the group E were shorter than those in group C (P < 0.05). No obvious bradycardia was observed in the two groups within 48 h after operation. The incidence of total adverse reactions in the group E within 48 h after surgery was lower than that in group C, especially the incidence of postoperative nausea and vomiting, the difference was statistically significant (P < 0.05).
ConclusionESPB combined with opioid-free general anesthesia has satisfactory clinical efficacy and less complication, which is beneficial for Rapid postoperative recovery.
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Keywords:
- general anesthesia /
- opioid-free drugs /
- erector spinae plane block /
- breast cancer surgery /
- nausea /
- vomiting
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表 1 2组患者一般情况比较(x±s)[n(%)]
指标 C组(n=29) E组(n=28) 年龄/岁 50.24±8.90 49.96±10.71 BMI/(kg/m2) 24.60±2.59 23.65±2.93 ASA分级 Ⅰ级 18(62.1) 19(67.9) Ⅱ级 11(37.9) 9(32.1) 既往史 高血压 8(27.6) 7(25.0) 糖尿病 2(6.9) 1(3.6) 化疗 1(3.4) 2(7.1) 手术类型 乳房全切除术伴前哨淋巴结活检 11(37.9) 12(42.9) 改良根治术(含腋窝淋巴结清扫) 18(62.1) 16(57.1) 手术时间/min 113.41±13.66 117.02±14.69 BMI: 体质量指数; ASA: 美国麻醉医师协会。 
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表 2 2组患者术中血流动力学指标比较(x±s)
指标 组别 T0 T1 T2 T3 T4 T5 MAP/mmHg C组(n=29) 96.72±8.71 78.00±6.59* 84.76±8.70* 89.41±8.93* 83.21±7.67* 97.55±9.37 E组(n=28) 96.00±8.40 82.96±6.82*# 85.61±7.19* 88.86±7.70* 84.79±7.02* 94.36±9.72 HR/(次/min) C组(n=29) 80.31±13.58 68.34±10.50* 70.83±10.82* 72.93±10.45* 68.72±10.65* 78.93±11.96 E组(n=28) 83.54±9.17 65.57±6.02* 67.21±6.02* 68.68±6.08* 61.25±6.53*# 75.39±9.84* MAP: 平均动脉压; HR: 心率。与T0比较, *P < 0.05; 与C组比较, #P < 0.05。
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表 3 2组患者术后静息和运动时VAS评分比较(x±s)
分 组别 指标 入PACU 术后2 h 术后6 h 术后12 h 术后24 h 术后48 h C组(n=29) 静息VAS评分 1.83±1.39 1.79±0.62 1.79±0.62 2.31±1.14 1.48±0.51 1.28±0.46 运动VAS评分 2.28±1.94 2.38±1.02 2.28±1.00 2.90±1.45 1.72±0.65 1.45±0.69 E组(n=28) 静息VAS评分 1.21±0.42* 1.39±0.63* 1.61±0.63 2.11±1.23 1.54±0.64 1.18±0.39 运动VAS评分 1.39±0.63* 1.93±0.90 2.29±1.01 2.68±1.52 1.89±1.07 1.36±0.49 与C组比较, *P < 0.05。
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表 4 2组患者术后恢复及不良反应发生情况比较(x±s)[n(%)]
指标 分类 C组(n=29) E组(n=28) 麻醉相关恢复时间 拔管时间/min 13.32±2.62 13.87±3.17 PACU停留时间/min 35.59±4.72 32.62±4.35* 术毕首次肛门排气时间/h 3.98±1.51 2.66±0.65* 术毕首次下床活动时间/h 13.90±3.47 14.05±3.39 术后48 h内不良反应 呼吸抑制 4(13.8) 0 躁动 3(10.3) 1(3.6) PONV 8(27.6) 1(3.6)* 合计 15(51.7) 2(7.1)* 与C组比较, *P < 0.05。
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