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目的:探讨超声下肋间神经阻滞用于乳腺癌根治术的麻醉效果。方法:选择2015年1月~2016年12月本院择期行乳腺癌根治术患者90例,随机分成(1)组、(2)组、(3)组,每组30例,(1)组超声肋间神经阻滞+喉罩全麻、(2)组传统盲法穿刺肋间神经阻滞+喉罩全麻、(3)组喉罩全麻。比较(1)组、(2)组、(3)组麻醉诱导前(T0)、切皮时(T1)、切皮后1h(T2)、拔除喉罩后5min(T3)的生命体征和应激反应相关指标水平的波动情况以及(1)组、(2)组的肋间神经阻滞效果。结果:(3)组T3时的MAP和HR水平明显高于T0时的水平,(3)组T3时的MAP和HR水平明显高于(1)组、(2)组;(1)组、(2)组T3时的A-Ⅱ水平明显高于T0时的水平,(3)组T1、T3时的Cor和A-Ⅱ水平均明显高于T0时的水平,(3)组T1、T3时的Cor和A-Ⅱ水平明显高于(1)组、(2)组;(1)组的阻滞起效时间、阻滞完善时间均明显快于(2)组,(1)组的镇痛维持时间明显长于(2)组;(1)组镇痛完全,(2)组有4例镇痛不全。结论:肋间神经阻滞复合喉罩全麻能更好维持术中血压和呼吸循环的稳定、减轻应激,尤其是超声下肋间神经阻滞的镇痛效果优于传统盲法穿刺肋间神经阻滞。
Objective: To investigate the anesthetic effects of intercostal nerve block under ultrasound for radical mastectomy of breast cancer. Methods: 90 patients undergoing elective radical mastectomy in our hospital from January 2015 to December 2016 were randomly divided into groups (1), (2) and (3) Ultrasound intercostal nerve block + laryngeal mask anesthesia, (2) group of traditional blind intercostal nerve intercostal laryngeal mask anesthesia, (3) laryngeal mask anesthesia. The vital signs of the rats in group (1), (2) and (3) before anesthesia induction (T0), skin incision (T1) and 1 h after skin incision (T2) Shock-related indicators of the level of fluctuations and (1) group, (2) intercostal nerve block effect. Results: (3) The levels of MAP and HR in group T3 were significantly higher than those in group T0 (3) The levels of MAP and HR in group T3 were significantly higher than those in group (1) and (2) (2) The level of A-Ⅱ in group T3 was significantly higher than that in T0. (3) The level of Cor and A-Ⅱ in group T1 and T3 were significantly higher than those in group T0. (3) The levels of Cor and A-Ⅱ in group (1) and group (2) were significantly higher than those in group (2) and group (1) Analgesic maintenance time was significantly longer than (2) group; (1) analgesic group completely, (2) group 4 cases of analgesia. Conclusion: The intercostal nerve block composite laryngeal mask general anesthesia can better maintain intraoperative blood pressure and respiratory cycle stability, reduce stress, especially the intercostal nerve block under ultrasound analgesic effect is better than the traditional blind intercostal space Nerve block.