氟比洛芬酯超前镇痛联合乳腺后间隙阻滞在乳腺微创旋切术后疼痛的效果观察

Flurbiprofen axetil Ester Preemptive Analgesia Combined with Retroareolar Space Block in the Effect of Pain after Breast Micro-Incision Biopsy

摘要: 观察氟比洛芬酯超前镇痛联合乳腺后间隙阻滞在乳腺微创旋切术后疼痛的效果。方法：选择拟在本医院施行乳腺微创旋切术患者60例，以手术时间为序随机分为实验组和对照组各30例；两组患者均采用丙泊酚复合瑞芬太尼静脉麻醉，实验组手术前25~30 min静脉注射氟比洛芬酯1 mg/kg，后行乳腺后间隙阻滞法，经超声引导进针至乳腺后间隙，将麻醉药物推注完成麻醉。对照组手术前给予0.9%生理盐水5 ml，行传统局部麻醉方法，以多点注射的方式，按照患者乳腺肿块部位，对肿块周围注射麻醉药物。观察两组患者手全身麻醉各个时间段的血流动力学指标、术中麻醉药物使用计量、疗效相关指标、患者满意度、VAS评分、感觉神经功能恢复时间及围术期不良反应指标等。结果：T1时刻、T2时刻两组患者心率、收缩压和舒张压差异无统计学意义(P > 0.05)，T3~T7时刻，实验组患者心率、收缩压和舒张压指标均显著低于对照组(P < 0.05)；实验组患者围术期相关指标均低于对照组(P < 0.05)，差异具有统计学意义(P < 0.05)；丙泊酚总用量实验组低于对照组，差异有统计学意义(P < 0.05)；实验组术后睁眼时间、自主呼吸恢复时间、复苏室停留时间均低于对照组；实验组患者满意度苏醒质量高于对照组，差异有统计学意义(P < 0.05)；VAS评分实验组患者清醒即刻、30 min、1 h、3 h均低于对照组，差异有统计学意义(P < 0.05)；实验组围术期不良反应低于实验组，差异有统计学意义(P < 0.05)。结论：氟比洛芬酯超前镇痛联合乳腺后间隙阻滞用于乳腺微创旋切术后疼痛效果可靠，提高镇痛效果和患者的舒适度，且对血流动力学影响小，不增加不良反应，具有良好的有效性和安全性。

Abstract: To observe the effect of preemptive analgesia with Flurbiprofen axetil combined with retromammary space block on pain after minimally invasive breast rotation. Methods: 60 patients who are going to undergo minimally invasive rotary mastectomy in our hospital were randomly divided into experimental group and control group in order of operation time, with 30 cases in each group. Patients in both groups were given propofol combined with remifentanil intravenous anesthesia. In the experimental group, 1 mg/kg of Flurbiprofen axetil was injected intravenously 25~30 min before operation, and then the retromammary space was blocked. The needle was inserted into the retromammary space under the guidance of ultrasound, and the anesthetic was injected to complete the anesthesia. The control group was given 5 ml of 0.9% normal saline before operation, and the traditional local anesthesia method was used, and anesthetic drugs were injected around the tumor according to the location of the breast tumor. Hemodynamic indexes, intraoperative anesthetic dosage, efficacy-related indexes, patient satisfaction, VAS score, recovery time of sensory nerve function and perioperative adverse reactions of the two groups were observed. Results: There was no significant difference in heart rate, systolic blood pressure and diastolic blood pressure between the two groups at T1 and T2 (P > 0.05). At T3~T7, the indexes of heart rate, systolic blood pressure and diastolic blood pressure in the experimental group were significantly lower than those in the control group (P < 0.05). The perioperative related indexes of patients in the experimental group were lower than those in the control group (P < 0.05), and the difference was statistically significant (P < 0.05). The total dosage of propofol in the experimental group was lower than that in the control group with statistical significance (P < 0.05). The time to open eyes, the recovery time of spontaneous breathing and the stay time in resuscitation room in the experimental group were lower than those in the control group. The patients’ satisfaction in the experimental group was higher than that in the control group, and the difference was statistically significant (P < 0.05). The VAS score of the experimental group was lower than that of the control group immediately after waking up, 30 min, 1 h and 3 h, and the difference was statistically significant (P < 0.05). The perioperative adverse reactions in the experimental group were lower than those in the experimental group, with statistical significance (P < 0.05). Conclusion: Preemptive analgesia with Flurbiprofen axetil combined with retromammary space block is reliable in pain relief after minimally invasive mastectomy, which improves the analgesic effect and patient’s comfort, has little influence on hemodynamics, does not increase adverse reactions, and has good effectiveness and safety.