标题：胸椎旁神经阻滞和肋间神经阻滞应用于乳腺肿物切除术的镇痛效果评价

      作者：蒋敢，曹艳，王军    武警陕西省总队医院麻醉科，陕西 西安 710054

      卷次： 2020年31卷18期

      【摘要】 目的 评价乳腺肿物切除术中不同麻醉方法的镇痛效果。方法 选择武警陕西省总队医院2017年2月至2019年1月择期乳腺肿物切除术患者80例，按随机数表法分为观察组和对照组各40例，观察组采用肋间神经阻滞麻醉，对照组采用胸椎旁神经阻滞麻醉，比较两组患者的手术时间、术中芬太尼及丙泊酚使用量、首次镇痛时间、术后24 h舒芬太尼使用量以及术后2 h、4 h、6 h、12 h、24 h的视觉模拟评分(VAS)。结果 两组患者的手术时间、术中芬太尼及丙泊酚使用量比较差异均无统计学意义(P>0.05)；观察组患者的首次镇痛时间为(171.4±10.9) min，明显长于对照组的(108.3±21.2) min，术后24 h舒芬太尼用量为(50.9±11.2) μg，明显少于对照组的(69.2±9.2) μg，差异均有统计学意义(P<0.05)；观察组患者术后4 h、6 h的VAS评分分别为(4.16±0.16)分、(3.96±0.13)分，明显低于对照组的(5.92±0.24)分、(5.52±0.25)分，差异均有统计学意义(P<0.05)；两组患者术后2 h、12 h、24 h的VAS评分比较差异均无统计学意义(P>0.05)。结论 乳腺肿物切除术选择肋间神经阻滞具有较好的镇痛效果，且可降低术后麻醉药物使用量，易被患者接受。
      【关键词】 胸椎旁神经阻滞；肋间神经阻滞；乳腺肿物；手术切除；镇痛；麻醉
      【中图分类号】 R655.8 【文献标识码】 A 【文章编号】 1003—6350（2020）18—2357—03

Analgesic effect of thoracic paravertebral nerve block and intercostal nerve block in mastectomy.
JIANG Gan, CAOYan, WANG Jun. Department of Anesthesiology, Shaanxi Provincial General Hospital of Armed Police, Xi'an 710054,Shaanxi, CHINA
【Abstract】 Objective To evaluate the analgesic effect of different anesthesia methods in breast tumor resec-tion. Methods Eighty patients undergoing mastectomy in Shaanxi Provincial General Hospital of Armed Police be-tween February 2017 and January 2019 were divided into the observation group (n=40) and the control group (n=40) ac-cording to the random number table. Patients in the observation group were given intercostal nerve block (INB), andthose in the control group were given thoracic paravertebral nerve block (TPVB). Then operation time, intraoperativeuse of fentanyl and propofol, first analgesia time, 24 h postoperative use of sufentanil, 2 h, 4 h, 6 h, 12 h, 24 h VASscore, patients’satisfaction, complication rate were compared between the two groups. Results There was no signifi-cant difference in operation time, fentanyl, and propofol dosage between the two groups (P>0.05); the first analgesiatime of the observation group was (171.4±10.9) min, significantly longer than (108.3±21.2) min in the control group, and24 h postoperative use of sufentanil was (50.9±11.2) μg, significantly less than (69.2±9.2) μg in the control group (P<0.05); the VAS score of the observation group at 4 h and 6 h after operation was (4.16±0.16) points, (3.96±0.13) points,significantly lower than (5.92±0.24) points, (5.52±0.25) points in the control group (P<0.05). There was no significant