美容整形门诊手术的麻醉处理

总结１９９３￣１９９５年４２０例美容门诊手术麻醉资料情况后，提出美容整形外科门诊手术大都是在局部麻醉下进行的，这时的整形外科医师具有手术医师和麻醉医师双重身份，对美容整形医生来说，掌握好局麻药的药理、熟练的麻醉技术对麻醉的安全和手术的成功是非常重要的，同时运用心理治疗对加强美容门诊的麻醉效果有很好的作用。     

美容整形门诊手术无痛麻醉的应用

目的：观察并总结美容整形非住院手术的无痛麻醉及处理，旨在消除求美者对手术的恐惧、焦虑和紧张情绪，更好的配合手术。方法：138例行美容整形手术的求美者，以异丙酚为主的静脉麻醉加局麻区域阻滞和肿胀麻醉，麻醉期间监测收缩压，舒张压、心率、血氧饱和度，统计了求美者恶心、呕吐的发生率，异丙酚的用量及术后恢复情况。结果：手术时间为30min-4．5h，麻醉后清醒睁眼时间为6-10min，术中及术后恶心呕吐发生率为1．47％。所有求美者均顺利完成手术，当日自行出院。结论：建立完善的麻醉门诊或会诊制。有效加强门诊手术的术前准备，提高手术的安全性，异丙酚是理想的药物，可消除局麻操作的痛感，根据手术时间长短联合应用芬太尼。咪唑安定及单用咪唑安定，减少了异丙酚的用量而不延长术后苏醒时间及恢复室停留时间。     

整形与美容手术中的躯体变形障碍

随着社会的进步，人们的求美之心日益增强。然而，在整形手术和皮肤美容中躯体变形障碍并不被太多医师所认识。对于躯体变形障碍国外的研究报道很多，但国内的研究开展较少。躯体变形障碍患者首先寻求的是整形手术或皮肤美容，很少一开始就寻求心理治疗。所以，该症若在临床中能被医师很好地识别，对增强手术效果、减少医疗纠纷大有裨益。     

整形：美丽的捷径

水桶腰、萝卜腿、眯眯眼、小乳房……是女性最大的遗憾,无计可施时她们会考虑最后的绝招——整形,重新订做一个完美的自我。     

美容整形患者的个人心理因素分析及临床治疗

美容整形手术是对某些外表缺陷进行治疗的有效方法,但却不是惟一的手段。如果能结合个体的心理特征开展心理辅导和术前术后的心理治疗,那么治疗效果将更加显著。尤其是当美容整形手术难度系数大且术后改进效果不明显时,心理的治疗和疏导更加重要。医护人员的所有言谈举止都会对求美者的认识、感受、行为和情绪产生影响。因此,要求美容整形外科的医护人员必须足够和蔼、耐     

整形美容与麻醉安全

医学整形美容行业在我国已经相当流行,然而,近年来我国连续发生了多起涉及美容麻醉医疗安全的事件,其主要原因是美容行业忽视了麻醉安全问题,为此,笔者从麻醉学的角度就＂整形美容与麻醉安全＂这一问题作一初步分析及讨论。     

门诊手术麻醉现况

门诊手术的旅行性在病人选择及术前准备、麻醉方式和用药选择、围术期的监测护理等方面都有特殊的要求，力求做到安全、舒适、有效、同时迅速回复，无残留作用及并发症。全麻用药中，吸入麻醉药如七氟醚、地氟醚，静脉麻醉药如异丙酚，镇痛药如阿芬太尼、雷米芬太尼、肌松工如美维松、罗库溴铵、这些药物的应用使门诊手术麻醉的实施更具有科学性和合理性。     

门诊手术麻醉现况

门诊手术的施行在病人选择及术前准备、麻醉方式和用药选择、围术期的监测护理等方面都有特殊的要求,力求做到安全、舒适、有效,同时迅速回复,无残留作用及并发症。全麻用药中,吸入麻醉药如七氟醚、地氟醚,静脉麻醉药如异丙酚,镇痛药如阿芬太尼、雷米芬太尼,肌松药如美维松、罗库溴铵,这些药物的应用使门诊手术麻醉的实施更具科学性和合理性。     

The effectiveness of benzodiazepines and narcotics in outpatient surgery

In a prospective study of 211 outpatients undergoing cosmetic surgical procedures under local anesthesia supplemented with intravenous diazepam and morphine, patient pain response to the local anesthetic infiltration was graded and the recall of the operative experience was assessed. One hundred and fifty-five patients (73%) had either no pain response or a mild response, 41 (19%) had a moderate response, and 15 (7%) had a severe response. One hundred and eighty-seven patients (88%) had total amnesia for the local anesthetic infiltration and the operative procedure, and 183 (87%) could not recall pain, but had recall of events during surgery. There were no untoward drug reactions nor episodes of cardiorespiratory depression. We conclude that intravenous diazepam with or without intravenous morphine following triazolam, morphine, and premethazine premedication is a safe and effective regimen, for outpatient surgery.     

超量灌注和肿胀麻醉在美容整形外科中的应用

超量灌注和肿胀麻醉都是局麻方法。超量灌注法是，在做脂肪抽吸时，应用０．０４％的利多卡因加入１／１００万肾上腺素做超剂量灌注，利多卡因的最大剂量可达５２．７ｍｇ／ｋｇ。其它如乳房整形、面部除皱手术等则可采用肿胀麻醉法，即将利多卡因稀释成０．０４％～０．１％的浓度，局部大量注射，使其肿胀，但利多卡因的总量仍可保持在６．４ｍｇ／ｋｇ的常规用量范围内。本组２８１例观察，麻醉镇痛完全者２４７例，占８７．９％；局部有痛感但可以忍受者为３１例，占１１．０４％；自觉不可忍受者为３例，占１．０６％。对有痛感者给予适量镇静镇痛药，未改用其它麻醉方法。故超量灌注和肿胀麻醉的方法可以安全有效地应用于大范围的美容整形外科手术，使手术更安全、出血少，患者恢复快。     

The psychology of aesthetic plastic surgery

Aesthetic plastic surgery and psychology are closely linked, as the aesthetic plastic surgeon is dealing with people's emotional, psychological, and social needs and aspirations. This article presents an overview of the relationship between the two professional disciplines. The minority of patients with psychiatric or psychological problems is described, and their treatment is considered in relation to both disciplines. We then move on to discuss the psychological and social issues that underlie mainstream aesthetic surgery in the context of the psychological theory of stigma. The role of the psychologist within aesthetic surgery is discussed.     

因特网上整形与美容外科资源获取技术

目的：探讨医学网络资源的一般获取技巧，以及医学整形与美容外科资源的获取途径。方法：应用因特网等关键词，采用医学专业检索引擎PubMed，并在此基础上链接其他医学检索引擎，获得有关整形与美容外科文献的网址和相关网页。结果：整形与美容外科的大型网站较少，但相关的学会、协会等研究机构的网站较多。结论：本丈具体阐述了整形与美容外科资源的获取途径和技巧。     

Psychological and aesthetic considerations in outpatient facial plastic surgery

The surgeon, medical and nonmedical staff, and the reception, consultation, treatment, surgical, and recovery areas constitute the basic elements of the office operating room complex. In reality these elements are an inseparable dynamic unit; however, for the purpose of discussion they have been examined separately to study their particular aesthetic and nonaesthetic psychological contributions to outpatient surgery. Knowing why a patient forms certain attitudes about the doctor, the office staff, and the office or suite and having some insight into how a patient perceives these same elements are very important to the young practitioner of facial plastic surgery. It is possible that in the contemporary medical world where there are many surgeons of equal ability, success may depend on understanding these psychological aspects.     

小儿和成人整形外科手术后早期低氧血症

700例施择期整形外科手术的病人,在麻醉恢复室用脉搏氧饱和度仪持续监测 SpO_2,以观察年龄对术后早期低氧血症的影响。根据年龄将病人分成四组:Ⅰ组为年龄小于1岁的婴儿;Ⅱ组为年龄1～3岁的幼儿;Ⅲ组为年龄大于3岁的儿童;Ⅳ组为年龄18～58岁的成人。结果发现年龄愈小,手术后早期的 SpO_2愈低,低氧血症的发生率愈高。到达麻醉恢复室后,Ⅰ、Ⅱ、Ⅲ、Ⅳ组病人的低氧血症发生率分别为44.4%、31.7%、17.3%和8.3%。婴儿的低氧血症主要发生在术后40分钟内,而1岁以上小儿和成人则主要发生在术后15分钟内。     

小儿和成人整形外科手术后早期低氧血症

７００例施择期整形外科手术的病人，在麻醉恢复室用脉搏氧饱和度仪持续监测ＳｐＯ２，以观察年龄对术后早期低氧血症的影响。根据年龄将病人分成四组：Ⅰ组为年龄小于１岁的婴儿；Ⅱ组为年龄１～３岁的幼儿；Ⅲ组为年龄大于３岁的儿童；Ⅳ组为年龄１８～５８岁的成人。结果发现年龄愈小，手术后早期的ＳｐＯ２愈低，低氧血症的发生率愈高。到达麻醉恢复室后，Ⅰ、Ⅱ、Ⅲ、Ⅳ组病人的低氧血症发生率分别为４４．４％、３１．７％、１７．３％和８．３％。婴儿的低氧血症主要发生在术后４０分钟内，而１岁以上小儿和成人则主要发生在术后１５分钟内。     

Career development resource for plastic and reconstructive surgery

Plastic surgery is a broad-based discipline with emphasis on areas such as breast, craniomaxillofacial, burn, aesthetic, and hand surgery as well as complex wounds and wound healing. Plastic surgery as a specialty captures a great deal of media attention over many other fields of medicine, so education, training, and credentialing have become an area of national interest. The purpose of this article was to provide information on the organization, basic requirements for training, fellowship, and volunteer opportunities within the specialty.     

国产膨体聚四氟乙烯在整形美容外科中的应用

目的评估国产膨体聚四氟乙烯(ePTFE)在整形美容外科中的临床效果. 方法采用国产ePTFE,以进口ePTFE作为对照,根据不同需要分别置于额部、颞部、鼻部、颏部、鼻基底及上颌部,矫正面部软组织缺损及凹陷畸形,比较2组术后伤口愈合、不良反应及临床效果. 结果试验组16例18个部位,术后随访6～9个月,其中1例(鼻部)因埋置过浅、过于接近切口继发感染而取出;1例(颏部)伤口愈合不良,假体外露,经换药后术后2周Ⅱ期愈合;其余病例临床观察未见明显过敏反应、炎症反应及排异反应,外形保持良好,满意率94.4%(17/18).对照组10例12个部位,术后随访6～9个月,1例(鼻部)假体外露取出,其余病例未出现异常情况,满意率为91.7%(11/12).2组在伤口愈合情况(χ2=1.109,P=0.574)、不良反应(P=1.000)和临床疗效(P=1.000)等方面均无显著性差异. 结论国产ePTFE具有良好的组织相容性,适合充填软组织,可作为安全而廉价的替代产品.     

Present status and future prospects for aesthetic plastic surgery

The recent developments and changes in surgical procedures such as rhytidectomy, blepharoplasty, nasoplasty, otoplasty, mammoplasty, mammary reconstruction, and abdominoplasty are briefly reviewed in this article, which is substantially reduced in its overall length from the guest lecture given by the author at the Seventh International Congress of Plastic and Reconstructive Surgery held in Rio de Janeiro in May 1979, in his role as president of the International Society of Aesthetic Plastic Surgery (ISAPS).