超声引导下TTP-PECS与TPVB对乳腺癌根治术围术期的镇痛效果及应激状况的影响.docx

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1、超声引导下TTP-PECS与TPVB对乳腺癌根治术围术期的镇痛效果及应激状况的影响王煜，赵婷JS空军军医大第一附属医院麻醉科陕西西安710032通讯作者：赵婷O摘要旧的探讨超声引导下胸横肌平面-胸神经阻滞(TTP-PECS)与胸椎旁神经阻滞(TPVB)对乳腺癌根治术围术期的镇痛效果及应激状况的影响。方法问顾性分析2018年3月至2023年3月我院接诊的72例乳腺癌根治术患者的临床资料，根据麻醉方式的不同分对照组和观察组各36例，对照组采用TPVB,观察组采用TTP-PECSo记录两组患者的围术情况、疼痛效果及术后2h(T1)12h(T2)、24h(T3)、48h(T4)视觉模拟疼痛评分(VAS

2、)和应激反应指标血浆肾素、血管紧张素II、醛固酮的变化情况。结果观察组输液量、失血量、手术时间、住院时间分别为(121.2018.63)min、(1149.20125.64)m1、(98.4720.16)mk(4.640.61)d,对照组输液量、失血量、手术时间、住院时间分把为(124.1820.75)min、(1151.38120.17)m1、(100.0519.24)m1、(4.700.57)d,两组术中输液量、失血量、手术时间和住院时间比较，差异无统计学意义(P0.05);观察组瑞芬太尼用量、镇痛泵有效按压次数、镇痛持续时间、术后再次镇痛分别为(277.134050)g(7.452.02

3、)次、(12.121.15)h、(2)例，对照组瑞芬太尼用量、镇痛泵有效按压次数、镇痛持续时间、术后再次镇痛分别为(279.0841.37)g(13.503.29)次、(9.481.77)h、(5)例，两组瑞芬太尼用量、术后再次镇痛例数比较差异无统计学意义(P0.05),观察组患者镇痛泵有效按压次数少于对照组，镇痛持续时间长于对照组，差异有统计学意义(P0.05);观察组T1、T2、T3、T4的VAS评分分别为(1.200.25)分、(1820.41)分、(2.120.50)分、(1.440.23)分，对照组T1、T2、T3、T4的VAS评分分别为(1.380.31)分、(3.040.58)分

4、、(3.880.66)分、(2.700.37)分，术后观察组在T1、T2、T3、T4的VAS评分均低于对照组，差异有统计学意义(PT2T3,T40t,观察组的血浆肾素水平分别为(0.600.11)ng/d1、(0.550.13)ngd1(0.640.12)ngd1(0.610.17)ngd1,对照组的血浆肾素水平分别为(0.680.17)ngd1(0.630.15)ngd1(0.790.16)ngd1(0.720.14)ngd1,观察组的血管紧张素的水平分别为(42.8311.16)ngd1(44.0511.30)ngd1(40.109.84)ngd1(39.2510.03)ngd1,对照组的

5、血管紧张素H的水平分别为(48.1910.30)ng/d1、(55.2412.09)ngd1(51.738.55)ng/d1、(47.1911.07)ngd1,观察组的醛固酮分别为(213.1918.24)ngd1(230.0825.63)ngd1(227.3623.70)ngd1218.2018.83)ngd1,对照组的醛固酮分别为(225.3016.15)ngd1(261.4727.19)ngd1(244.0521.27)ngd1(231.172455)ngd1,术后观察组在T1、T2、T3、T4血浆肾素、血管紧张素II、醛固酮的指标水平均低于对照组，差异有统计学意义(P0.05);int

6、heobservationgroup,thedosageofremifentani1,thenumberofeffectivepressingofana1gesiapump,thedurationofana1gesiaandpostoperativeana1gesiawere(277.13土40.50)g,(7.452.02)times,(12.121.15)hand(2)casesrespective1yjnthecontro1group,thedosageofremifentani1,thenumberofeffectivepressingofana1gesiapump,thedurati

7、onofana1gesiaandpostoperativeana1gesiawere(279.0841.37)g,(13.503.29)timesand(9.08土41.37)g,(13.50土3.29)times,(9.481.77)h,(5)cases,therewasnosignificantdifferenceinthedosageofremifentani1andthenumberofcasesofpostoperativereana1gesiabetweenthetwogroups(P0.05),thenumberofeffectivepressingofana1gesiapump

8、intheobservationgroupwas1essthanthatinthecontro1group,andthedurationofana1gesiawas1ongerthanthatinthecontro1group,andthedifferencewasstatistica11ysignificant(P0.05);theVASscoresoftheobservationgroupT1,T2,T3,andT4were(1.200.25)scores,(1.820.41)scores,(2.120.50)scores,(1.440.23)scoresrespective1y,thec

9、ontro1groupT1,T2,T3,TheVASscoresofT4were(1.380.31)scores,(3.040.58)scores,(3.880.66)scores,(2.700.37)SCoreS,theVASscoresofT1,T2,T3andT4intheobservationgroupwere1owerthanthoseinthecontro1group,andthedifferencewasstatistica11ysignificant(P0.05);atT1,T2,T3,andT4,thep1asmarenin1eve1softheobservationgrou

10、pwere(0.600.11)ngd1,(0.550.13)ngd1,(0.640.12)ngd1,(0.610.17)ngd1,thep1asmarenin1eve1softhecontro1groupwere(0.680.17)ngd1,(O.63O.15)ngd1,(0.790.I6)ngd1,(0.720.14)ngd1,observethe1eve1sofangiotensinIIinthegroupwere(42.8311.16)ngd1,(44.0511.30)ngd1,(40.109.84)ngd1,(39.2510.03)ngd1,theb1oodvesse1softhecontro1groupthe1eve1sofangiotensinIIwere(48.1910.30)ngd1,(55.2412.09)ngd1,(51.738.55)ngd1,(47.1911.07)ngd1,thea1dosteroneoftheobservationgroupwere(213.1918.24)ngd1,(230.0825.63)ngd1,(227.3623.70)ngd1,(218.2018.83)ngd1,thea1dosteroneofthecontro1groupwere(225.3016.15)n