摘要
目的评价胸横肌平面-胸神经(TTP-PECS)阻滞辅助下羟考酮-丙泊酚少阿片全身麻醉在乳腺癌保乳术中的有效性及安全性。方法纳入2023年9月至2024年8月因乳腺癌择期行保乳手术的患者60例,随机均分至少阿片全麻组(TO组)和常规全麻组(GA组)。记录两组患者不同时点[全麻诱导前(T_(0))、喉罩置入前即刻(T_(1))、手术切皮时(T_(2))、完整切除乳腺标本时(T_(3))、手术结束时(T_(4))]的MAP和HR;记录两组患者术后2、6、24、48 h安静及运动状态时NRS评分;记录两组患者术后48 h内使用氟比洛芬酯行补救镇痛的例数和首次需求时间;评估两组患者术前和术后24 h的15项恢复质量(the 15-item quality of recovery,QoR-15)量表评分;观察并记录TO组患者穿刺部位感染、出血、气胸、局麻药毒性反应等神经阻滞相关并发症的发生率以及术中需持续泵注瑞芬太尼的例数;并观察两组患者围术期不良反应的发生率。结果与GA组比较,TO组于T_(2)、T_(3)时点MAP、HR均显著降低(P<0.05);术后2、6 h安静及运动状态NRS评分亦显著降低(P<0.05)。TO组术后48 h内补救镇痛率显著低于GA组(P<0.05),且术后首次补救镇痛时间较GA组显著延迟(P<0.05)。TO组术后24 h的QoR-15评分显著高于GA组(P<0.05)。TO组所有患者均未发生与TTP-PECS阻滞相关的穿刺部位感染、出血、气胸、局麻药毒性反应等并发症,且所有患者均无需另外持续泵注瑞芬太尼辅助麻醉镇痛。TO组患者咳嗽反射的发生率较GA组显著降低(P<0.05),两组患者围术期不良反应发生率差异无统计学意义(P>0.05)。结论羟考酮-丙泊酚少阿片全身麻醉下TTP-PECS阻滞用于乳腺癌保乳手术安全有效,术中无需使用舒芬太尼、瑞芬太尼,可提供稳定的血流动力学,减轻应激反应,并能有效提高围术期镇痛效果,促进患者术后早期恢复。
Objective To evaluate the efficacy and safety of the oxycodone-propofol opioid-sparing general anesthesia protocol,which is aided by transversus thoracic muscle plane-pectoral nerves(TTP-PECS)block,in patients undergoing breast-conserving surgery.Methods From September 2023 to August 2024,a total of 60 patients scheduled for breast-conserving surgery were enrolled and randomly allocated to either an opioid-sparing general anesthesia group(group TO,n=30)or a conventional general anesthesia group(group GA,n=30).The mean arterial pressure(MAP)and heart rate(HR)at different time points were precisely recorded.The Numerical Rating Scale(NRS)scores at rest and during movement at 2,6,24,and 48 hours post-operatively were meticulously documented.For both groups,the number of patients who required rescue analgesia with flurbiprofen axetil within 48 hours post-operatively,as well as the time to the first request,was accurately recorded.The scores of the 15-item quality of recovery(QoR-15)scale were comprehensively assessed at 24 hours before and after surgery.The incidence of nerve block-related complications(e.g.,puncture site infection,bleeding,pneumothorax,local anesthetic systemic toxicity)in group T_(0) and the number of patients who needed continuous remifentanil infusion were carefully observed.The two groups were also compared regarding the incidence of perioperative adverse events.Results Compared to group GA,group T_(0) exhibited significantly lower MAP and HR at the intraoperative time points T_(2) and T_(3)(P<0.05).Postoperatively,group T_(0) also had significantly lower NRS scores at rest and during movement,both at 2 hours and 6 hours(P<0.05).The rescue analgesia rate within 48 hours postoperatively was significantly lower in group T_(0) than in group GA(P<0.05),and the time to first rescue analgesia was significantly later in group T_(0) compared to group GA(P<0.05).The QoR-15 score at 24 hours postoperatively was significantly higher in group T_(0) than in group GA(P<0.05).No complications related to trans-thoracic paravertebral-pectoral nerve block(TTP-PECS block),such as puncture site infection,bleeding,pneumothorax,or local anesthetic toxicity,occurred in group T_(0),and none of the patients in group T_(0) required additional continuous remifentanil infusion for analgesia.The incidence of cough reflex was significantly lower in group T_(0) than in group GA(P<0.05).There were no statistically significant differences in the incidence of postoperative adverse events between the two groups(P>0.05).Conclusions The administration of TTP-PECS block during oxycodone-propofol opioid-sparing general anesthesia has demonstrated safety and efficacy in breast-conserving surgery.This technique obviates the requirement for intraoperative sufentanil or remifentanil,maintains stable hemodynamics,mitigates the stress response,effectively enhances perioperative analgesia,and improves the quality of early postoperative recovery.
作者
孙正霞
张林
常家琦
谢晖
刘辉
卞清明
SUN Zhengxia;ZHANG Lin;CHANG Jiaqi;XIE Hui;LIU Hui;BIAN Qingming(School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,Jiangsu,China;Department of Anesthesiology,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu,China;Department of Breast Surgery,Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,Jiangsu,China)
出处
《实用医学杂志》
北大核心
2026年第5期734-741,共8页
The Journal of Practical Medicine
基金
国家自然科学基金资助项目(编号:82272916)
江苏省卫生健康委干部保健科研项目(编号:BJ20028)
江苏省肿瘤医院科技发展基金项目(编号:QZLC202417)。
关键词
胸横肌平面
胸神经阻滞
羟考酮
丙泊酚
全身麻醉
乳腺癌
transversus thoracic muscle plane
pectoral nerves block
oxycodone
propofol
general anesthesia
breast cancer
