全麻和高位硬膜外联合臂丛麻醉在乳腺癌手术中的比较

目的 观察两种不同的麻醉方法用于乳腺癌根治术对呼吸循环功能的影响以及并发症的发生率.方法 选择诊断明确的乳腺癌患者120例,ASAⅠ～Ⅱ级,随机分为两组.A组66例采用气管插管静脉复合麻醉,B组54例采用高位硬膜外麻醉联合臂丛神经阻滞.结果 A组患者麻醉后平均动脉压(MAP)、心率(HR)相对平稳;B组患者麻醉后MAP下降,HR减慢,与A组比较差异有统计学意义(P<0.05).B组患者麻醉后呼吸抑制发生率较高,脉搏氧饱和度(SpO2)在麻醉后、切皮时及切皮后10 min均低于基础值,A组麻醉后无呼吸抑制,特别在切除腋窝淋巴结时由于静脉注射氯胺酮而引起一过性SpO2下降.B组患者的术中知晓率及麻黄素和阿托品的应用率均高于A组(P均<0.05).结论 气管插管静脉复合麻醉用于乳腺癌根治术具有安全、麻醉效果确切、术中血流动力学平稳等优点,避免了由高位硬膜外麻醉引起的呼吸抑制、硬膜外血肿等一系列并发症.Abstract：Objective To observe the effect of breath and circulation and the incidence rate of complication during the breast cancer radical correction with this two methods of anaesthesia. Methods To select 120 patients,all definite diagnosed breast cancer,ASAⅠ-Ⅱdegree,and divided into two groups(group A and group B)at random. Group A received tracheal intubation balanced anesthesia;Group B received high epidural anesthesia with plexus brachialis nerves block. Results The patients of group A with a correspondence MAP and HR after anaesthesia;while MAP decrease(P<0.05) and HR step down (P<0.05) on the patients in group B,compare with group A has obvious statistical significance.The incidence rate of respiratory depression in group B was high, all the SpO2 after anaesthesia, the time of cutting skin and after cut skin 10 min under the base value. None respiratory depression in group A, especially SpO2 temporal descend because of intravenous injection the ketamine when ablate axillary nodes. The rate of awareness in group B, admove ephedrine and atropinic are all higher than that in group A(P<0.05).Conclusions Received tracheal intubation balanced anesthesia in the breast cancer radical correction has several good quality,such as safety, the effect of anesthesia is precisely,an equability haemodynamics;hemodynamics during the operation, to avoid respiratory depression and epidural hematoma;extradural hematoma and other complication originated by the epidural anesthesia.

Comparison of entire anaesthesia and high epidural anesthesia with plexus brachialis nerves block during the operation of breast cancer

Breast cancer radical correction Tracheal intubation balanced anesthesia Epidural anesthesia