超声引导下后路肋间神经阻滞在乳腺肿块切除术中的应用

目的探讨超声引导下后路肋间神经阻滞用于乳腺肿块切除术的安全性及有效性。方法将60例行乳腺肿块切除术的患者按不同的麻醉方式分为2组。超声引导下后路肋间神经阻滞组(A组,30例),传统神经阻滞组(B组,30例)。观察2组患者神经阻滞前(T0),神经阻滞后1(T1)、5(T2)、10(T3)min,手术结束时(T4)的RR、心率(HR)、血压收缩压(SBP)、舒张压(DBP)]、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及VAS评分等情况。记录2组患者手术时间、神经阻滞所用时间及肋间血管刺中率(回抽时有血)和并发症(气胸、局部麻醉药中毒)发生率、阻滞失败后麻醉方式改变的例数等。结果 A组患者在T1、T2、T3、T4时RR、HR、SBP、DBP、MAP、SpO2值与B组比较差异均无统计学意义(均P>0.05)。A组患者在T1时VAS评分较B组显著降低(P<0.05)。A组在神经阻滞麻醉过程中无一例(0.0%)肋间血管刺中,B组有6例(20.0%)肋间血管刺中,B组较A组明显增多(P<0.05);B组因神经阻滞效果不佳导致麻醉方式改变较A组明显增多(P<0.05)。结论超声引导下后路肋间神经阻滞可安全、有效地应用于乳腺肿块切除术中。

Clinical Application of Ultrasound-guided Posterior Approach to Intercostal Nerve Block in Breast Lump Resection

Objective To evaluate the safety and efficiency of ultrasound-guided posterior approach to intercostal nerve block for breast lump resection.Methods Sixty patients scheduled to undergo breast mass excision were randomly assigned to receive intercostal nerve block using either an ultrasound-guided posterior approach(group A,n=30) or a traditional approach(group B,n=30).Respiratory rate(RR),heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),pulse oximetry(SpO2) and VAS scores were determined before nerve block(T0),at 1(T1),5(T2) and 10 minutes(T3) after nerve block,and at the end of surgery(T4).Operation time,the time of block performance,stabbed intercostal vessel rate,complications(pneumothorax and local anesthetics poisoning),and the number of patients who required conversion to general anesthesia for failed block were recorded in both groups.Results There were no significant differences in the RR,HR,SBP,DBP,MAP and SpO2 between the two groups at each time point of the T1,T2,T3,T4(P>0.05).Compared with group B,VAS scores measured at T1 and the number of patients who required conversion to general anesthesia for failed block obviously decreased in group A(P<0.05).In addition,stabbed intercostal vessel rate in group A was significantly lower than that in group B(0.0% vs 20.0%,P<0.05).Conclusion Ultrasound-guided posterior approach to intercostal nerve block is safe and effective for breast lump resection.