目的：评估超声引导椎旁阻滞对乳腺癌患者早期术后恢复质量的影响。方法纳入全身麻醉下行乳腺癌改良根治手术患者74例，年龄18~60岁，美国麻醉医师协会（American society of anesthesiologists ，ASA）分级为Ⅰ~Ⅱ级，随机分为椎旁阻滞组和对照组（每组37例）。椎旁阻滞组：超声引导下行手术侧椎旁阻滞，第一胸椎到第五胸椎（T1～T5）每个节段注射3 ml，总共注射0.5%罗哌卡因15 ml；对照组未进行椎旁阻滞。观察指标为患者术后24小时恢复质量（QoR-40评分）、患者术后24小时静息状态疼痛程度（平均VAS评分、最高VAS评分和累积舒芬太尼追加剂量）、恶心呕吐等不良反应发生率和患者满意度评分。结果与对照组比较，椎旁阻滞组患者术后24小时QoR-40评分升高[183分(172～189分) vs.168分(154～182分)]；术后镇痛效果较好（平均VAS评分和最痛VAS评分降低，累积舒芬太尼追加剂量减少）；术后恶心、呕吐发生率降低；患者满意度提高。以上各项指标差异均有统计学意义（P<0.05）。结论超声引导椎旁阻滞可提高全身麻醉下乳腺癌改良根治术后患者早期恢复质量，减轻术后疼痛，减少术后恶心、呕吐等不良反应，从而提高患者满意度。%Objective To evaluate the effects of ultrasound-guided paravertebral blocks (PVB) on the postoperative recovery quality after modified radical mastectomy of patients undergoing general anesthesia.Method Seventy-four American Society of Anesthesiologists (ASA) physical statusⅠorⅡpatients undergoing modified radical mastectomy were randomly allocated to PVB group and control group. The PVB group received T1~T5 PVBs with 3ml of 0.5% ropivacaine per level, whereas the control group received no PVB. The observing indexes included the quality of recovery, which was assessed on the day before surgery and 24h after surgery using the Quality of Recovery 40 questionnaire (QoR-40), postoperative rest pain intensity, incidence of postoperative nausea and vomiting (PONV) and patient’s satisfaction report.Result Global QoR-40 score at 24 h after surgery was higher in the PVB group than that in the control group, [183(172~189)]vs.[168 (154~182)]. Compared with the control group, postoperative rest pain intensity and the cumulative doses of sufentanil were lower in the PVB group patients. Ultrasound-guided multilevel paravertebral blocks reduced the incidence of PONV and improved the patient’s satisfaction scores.Conclusion Ultrasound-guided multilevel paravertebral blocks can enhance the quality of recovery, postoperative analgesia and patient’s satisfaction after general anesthesia for modified radical mastectomy.
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