水射流辅助吸脂临床应用初探

目的 初步探讨水射流辅助吸脂的临床效果和安全性.方法 对121例患者行水射流辅助吸脂,记录手术时间、注入肿胀液量、冲洗液量、吸出总液体量、吸出脂肪量、术后疼痛时间、感觉恢复时间,观察吸出物颜色、术中术后患者的生命体征、皮肤瘀斑和水肿的程度、皮肤平整度以及利多卡因毒性反应等,随访患者手术的满意度.结果 本组患者平均手术时间2.5h,平均吸脂2.4个部位,平均注入肿胀液量1370ml,平均注入冲洗液量8750ml,平均吸出总液体量9240ml,平均吸脂量1720ml,平均疼痛恢复时间为5d,平均感觉恢复时间为23d.所有患者的生命体征平稳,术后第3天时皮肤平整,皮肤瘀斑和水肿程度较轻;术后6个月随访114例,满意率为94.2%,吸脂部位皮肤平坦、无感染、血肿、皮肤坏死、利多卡因中毒等并发症.结论 水射流辅助吸脂对神经、血管的损伤小,组织肿胀轻,可降低药物用量和手术风险,为大容量吸脂术提供了安全保障.     

局部大量体外超声吸脂的安全性评价及体会

目的:探讨行局部体外超声大量吸脂的安全性。方法:对400例肥胖患者464个部位行体外超声吸脂术,记录局部吸出脂肪量、注入肿胀液量,注入利多卡因浓度,观察术中术后患者生命体征及利多卡因毒性反应,并发症出现情况。结果:其中吸出脂肪量超过4000ml共124个部位(腰腹部76例,大腿48例),局部大量体外超声吸脂术中、术后患者生命体征均平稳,术后无一例出现休克、严重利多卡因中毒症状,术后恢复正常,无感染、皮肤坏死、不平坦及松弛等其它并发症发生。结论:局部肿胀麻醉下行大量体外超声吸脂是安全、可靠的。     

腰腹部吸脂大容量肿胀麻醉安全性分析

目的:探讨以肿胀麻醉技术一次性吸出3000ml以上脂肪的手术安全性。方法:73例女性,年龄19～62岁,一次性吸出腰腹部脂肪3000～7700ml。统计手术中肿胀液的注射量、利多卡因用量。连续观察术中、术后病人的临床反应和生命体征。结果:肿胀液注射量4000～11500ml,利多卡因用量38.10～92.00mg/kg体重。术中麻醉效果满意,出血少,未见血压降低、呼吸困难、头痛、耳鸣等症状。术后发生体位性低血压11例,发生率15.07%,平卧和补液后即恢复。受术者体形均有明显改善,多数患者体重下降,效果满意。结论:在肿胀麻醉技术下一次性吸出大量腰腹部皮下脂肪是有一定风险的,术后应常规留院观察12h以上。     

肿胀技术下负压吸脂与超声吸脂术的比较

为比较肿胀技术下负压吸脂术与超声吸脂术的优缺点 ,1 996年 1月～ 1 998年 1月我们各以 35例进行对比观察 ,现报告如下。1　材料与方法两组均为女性 ,在年龄、肥胖类型、吸脂部位等差异均无显著性意义。术前触摸 5cm宽的皮肤皮下脂肪厚度、腹部围度测定等差异也无显著性意义 ( P>0 .0 5,表 1～ 3)。肿胀液配方及注射方法见文献 [1 ],用量为每例1 50 0～ 1 0 0 0 0 ml,平均 60 0 0 ml。超量灌注的标准 :吸脂部位明显肿胀、坚韧、皮肤变白、呈轻度桔皮样外观。利多卡因用量 :( 36.2± 1 1 .7) mg/kg体重 ,最大量 63.6mg/kg体重。两组间应用…     

布比卡因和利多卡因肿胀液在局麻吸脂术中的应用效果比较

目的:结合在局麻吸脂术使用布比卡因的经验探讨肿胀液中布比卡因的安全使用、组成及其有效性。方法:选择2013年6月-2019年2月135例不同部位进行局麻负压吸脂的患者为研究对象,肿胀液主要成分为布比卡因和利多卡因,评估应用含布比卡因和利多卡因肿胀液在吸脂术中的药物组成、用量、疗效和安全性。结果:局麻吸脂中含布比卡因结合利多卡因的肿胀液适合于吸脂量低于4800ml的患者,仅含布比卡因一种麻醉药物的肿胀液在吸脂量为3600ml,布比卡因总用量为252mg(文献值为150mg)时未显示毒性;含布比卡因肿胀液组镇痛效果好于利多卡因组,术中起效快,术后1~4d无痛苦、恢复快、愈合好、并发症少、住院时间缩短一半。结论:布比卡因及布比卡因结合利多卡因的肿胀液在局麻吸脂中具有镇痛效果好、手术安全等优点,为其进一步应用提供了宝贵经验。证明布比卡因、尤其是布比卡因结合利多卡因作为肿胀液的麻醉药物值得进一步推广。     

脂肪抽吸术中肿胀麻醉液留置时间和温度对出血量的影响

目的 观察脂肪抽吸术中肿胀麻醉液在皮下留置时间及温度对出血量的影响.方法 对20例美容就医患者进行脂肪抽吸术,其中10例行双上臂脂肪抽吸,另10例行双大腿脂肪抽吸,分别计算肿胀麻醉液于皮下留置不同时间和不同温度时的手术出血量.结果 20例术后出血量在21.42～77.26 ml,平均为(50.27±18.56) ml.其中肿胀麻醉液在右上臂皮下留置0.5h后进行脂肪抽吸,平均出血量为(19.89±7.52) ml,肿胀麻醉液注射完毕左上臂即行脂肪抽吸,平均出血量为(26.25±12.07) ml;右下肢使用加热至37℃的肿胀麻醉液,平均出血量为(28.60±6.07) ml,左下肢使用未加热的肿胀麻醉液(23℃),平均出血量为(29.93±9.06) ml.结论 肿胀麻醉液注射完成后留置0.5h可有效降低手术出血量.使用加热至37℃的肿胀麻醉液不增加术中出血量.     

持续硬膜外麻醉下行大量体外超声吸脂术的体会

目的：评价持续硬膜外麻醉下行大量体外超声吸脂的疗效及安全性,并总结经验。方法：对15例肥胖患者在持续硬膜外麻醉下行体外超声吸脂术（其中腰腹部6例,大腿部9例）,记录注入肿胀液量、吸出纯脂肪量,术前术中术后患者生命体征、血液成分变化,并观察并发症出现情况。结果：吸出脂肪量3300～4800ml,平均4100ml;11例短期内均出现血压下降、脉搏加快,皮肤、粘膜苍白,心悸,全身乏力,恶心、呕吐,纳差,眩晕等血容量不足的表现,查见红细胞、血红蛋白明显降低;术后恢复时间较局部肿胀麻醉者长,平均5天（以术后患者可自行下地行走,无明显不适为限）,局部瘀紫严重,无感染、皮肤坏死、不平坦及松弛等其它并发症发生。结论：持续硬膜外麻醉下行大量体外超声吸脂需慎重,并要切实做好术前准备及术后处理。     

微创方法行双下肢超大容量吸脂一例

1 临床资料 患者女,20岁.自幼全身性肥胖,双下肢尤为明显,随着年龄的增长,肥胖逐渐加重,既影响形体的外观,又使双大腿内侧严重磨擦.于2004年8月4日来院就诊,查体:身高176 cm,体重105 kg.既往无其他病史及服药史,心电图、血常规、血凝四项、肝功等检查无异常,其中红细胞为4.09×1012/L,血红蛋白为123 g/L,总蛋白为82 g/L.诊断:单纯性肥胖.无手术禁忌,根据手术适应证及患者情况,先行下臀部及双大腿部吸脂,Ⅱ期行上臀部吸脂.采用肿胀麻醉行下臀部及双大腿部体外超声辅助吸脂术,给予心电监护.术中注入肿胀液(2%利多卡因15 ml,肾上腺素0.4 mg,5%碳酸氢钠6 ml,复方氯化钠500 ml)12 500 ml,利多卡因总量71.4 mg/kg;共吸出液体总量14 600 ml,其中纯脂肪量13 200 ml,清除术区肿胀液,缝合切口,放置引流条,加压包扎.手术经3 h,术中共输入液体2100 ml,患者生命体征稳定,术区偶有痛感,但可以忍受,无其他不适.术后静脉输入抗生素、补充液体共2500 ml,未输血,持续心电监护,严密监测生命体征.术后24 h,患者生命体征平稳,尿量共1600 ml,术区疼痛,于下床活动时明显,但可以忍受,换药时,见术区皮肤无破溃坏死,未见明显瘀斑,去除引流条,结扎切口,穿弹力裤.     

下肢体外超声吸脂的疗效及操作技巧

目的　探讨体外超声吸脂术治疗下肢大小腿脂肪堆积的疗效、安全性 ,以及对操作技巧进行总结。方法　接受吸脂者共 81例 ,根据其要求 ,分别对大腿部 (6 0例 )以及小腿部 (2 1例 )进行体外超声吸脂术 ,记录所注入的麻醉药量和吸出的纯脂肪量 ,以及吸前和吸后 1～ 3个月的腿围变化。结果　大腿部人均吸出脂肪量 36 73ml,最高吸出量 6 10 0ml;大腿正中围缩小 (4.6 5± 1.10 )cm ,最大缩小 12 .5cm。小腿人均吸出脂肪量 6 5 0ml,最高吸出量 12 0 0ml;小腿正中围缩小 (3± 1.0 2 )cm ,最大缩小 9cm。吸脂疼痛程度较轻、出血量少、吸后皮肤平坦、无严重并发症发生、无反弹迹象。在操作过程中 ,熟知腿部脂肪分布特点 ,注射麻醉药量充分、均匀 ,超声时间适度 ,吸刮层次准确是手术成功的根本保障。结论　体外超声吸脂用于腿部脂肪堆积的治疗 ,是一种安全、可靠、有效的方法 ,医师的熟练操作技巧是手术成功至关重要的因素。     

肿胀吸脂术疗效与并发症分析

目的　探讨肿胀吸脂术的疗效与并发症的预防。方法　应用肿胀技术对 2 69例进行腹部、大腿等部位吸脂术 ,利多卡因总量最大 3 0 0 0mg ,43mg kg ,吸脂最大量为 475 0ml。结果　本组有术后吸脂部位不平、血清肿等并发症 ,但没有出现利多卡因中毒及肺栓塞等严重并发症 ,大部分受术者对术后效果满意。结论　肿胀吸脂术是一种安全有效的减肥方法。术中需注意操作技巧 ,以预防或减少并发症的发生     

When One Liter Does Not Equal 1000 Milliliters: Implications for the Tumescent Technique

BACKGROUND: Tumescent anesthesia has revolutionized the practice of liposuction. Inherent to the tumescent technique is the use of large volumes of dilute solutions of lidocaine with epinephrine instilled into subcutaneous fat deposits. Precise formulation of the tumescent anesthesia is essential to liposuction technique. OBJECTIVES: To determine the actual volumes of fluids contained in intravenous (IV) 1 L bags of saline used for tumescent anesthesia, to calculate volumes supplied in 50 cc stock solutions of 1% lidocaine, and to measure the amount of fluid retained by peristalic pump tubing used for infiltration. METHODS: The amount of saline contained in fifteen 1 L saline bags from three different manufacturers was calculated using graduated cylinder methodology. The volume of tumescent anesthesia retained by peristaltic pump tubing was calculated by expelling the contents of the filler tubing and measuring it. The actual amount of 1% lidocaine contained within fifteen 50 ml "stock" 1% lidocaine bottles from different manufacturers and with different lot numbers was calculated by transferring the contents into graduated cylinders. RESULTS: One liter IV bags of physiologic saline contained an average volume of 1051 ml (range 1033-1069 ml). The 50 ml bottles of 1% lidocaine with epinephrine contain an average of 54 ml of anesthetic (range 52.5-55 ml). Infusion tubing for use with peristaltic pumps may retain 46-146 ml of tumescent anesthesia. CONCLUSION: One liter IV bags of normal saline contain more than 1 L, having an average volume of 1051 ml. Common methods of preparation of 0.05% lidocaine with 1:1,000,000 epinephrine and sodium bicarbonate can increase the total amount of fluid in the tumescent anesthesia to 1112 ml for 0.05% solutions and preparation of a 0.1% solution contains an average volume of 1162 ml. The fluid contained in each bag may be increased over labeling by as much as 11-16%. Final concentrations of lidocaine in tumescent anesthesia may be reduced due to extra fluids. A 0.05% lidocaine solution may have a final lidocaine concentration of 0.045% and a 0.1% lidocaine solution may have an actual concentration of 0.086%. Lidocaine concentrations may be reduced by as much as 10-14%. Extra anesthesia fluid is also contained within stock 50 ml bottles of 1% lidocaine. Dermatologic surgeons should be aware of extra fluid possibly contained within tumescent anesthetic preparation, be aware of the extra anesthesia supplied in standard 1% lidocaine bottles, and possible decreased concentration of lidocaine within the final tumescent anesthesia.     

吸脂术中大剂量使用利多卡因的血药浓度监测及意义

目的探讨作为局部麻醉剂的利多卡因在肿胀法脂肪抽吸术中的极限剂量是多少,既能达到良好的镇痛效果,又能安全地使用而不产生毒副作用。方法对１４例大剂量使用低浓度利多卡因作为局麻药的脂肪抽吸术的术中和术后血清利多卡因浓度以免疫荧光测定法进行了动态监测,作出其时间浓度曲线,并与临床表现相对照。结果在此类手术中,利多卡因在０１ｍｇ／ｍｌ的浓度下,加入１／１百万～１／２百万肾上腺素,其用量可达３５ｍｇ／ｋｇ体重而血清高峰浓度仍在安全范围内,无中毒症状,既可减轻病人的疼痛,又可减少出血,提高安全性,增加脂肪抽吸量。结论本研究为肿胀法吸脂术中大剂量使用利多卡因的临床实践提供了理论依据。     

吸脂术中大剂量使用利多卡因的血药浓度监测及意义

目的 探讨作为局部麻醉剂的利多卡因在肿胀法脂肪抽吸术中的有限剂量是多少，既能达到良好的镇痛效果，又有安全地使用而不产生毒副作用。方法 对１４例大剂量使用低浓度利多卡因作为局麻药的脂肪抽吸术的术中和术后血清利多卡因浓度以免疫荧光测定法进行了动态监测，作出其时间－浓度曲线，并与临床表现相对照。结果 在此类手术中，利多卡因在０．１ｍｇ／ｍｌ的浓度下，加入１／１百万￣１／２百万肾上腺素，其用量可达３５ｍｇ     

Lidocaine Levels During the First Two Hours of Infiltration of Dilute Anesthetic Solution for Tumescent Liposuction: Rapid Versus Slow Delivery

BACKGROUND: Tumescent anesthesia for liposuction with dilute lidocaine has been well documented to result in peak serum levels 4-14 hours after infiltration. Pharmacokinetic studies have shown that the rate of lidocaine absorption is related not only to dilution, but also to the speed of subcutaneous infiltration. Early studies with a more concentrated solution of lidocaine (1.0%) have shown that with rapid infusion, peak plasma levels may occur within 30 minutes. OBJECTIVE: To determine whether rapid absorption of lidocaine may occur during infusion of tumescent solution by varying the rate of infusion of dilute lidocaine solution (0.05% or 0.1%) and observing serum levels of lidocaine within the first 2 hours of the procedure. METHODS: Eighteen patients participated in this study and were infused with a standard liposuction tumescent formula consisting of lidocaine either 0.05% or 0.1%. The rates of infusion of tumescent anesthesia ranged from 27.1 mg/min up to 200 mg/min infused over a period of 5 minutes to 2 hours. Total lidocaine infused ranged from 7.4 to 57.7 mg/kg. Serum levels of lidocaine were taken every 15 minutes during the first hour of the procedure and repeated at 2 hours. RESULTS: In all 18 patients, lidocaine levels remained significantly below the toxic range and were always less than 2.0 microgram/ml. In 11 patients, lidocaine levels at all time intervals were less than 0.5 microgram/ml. In seven patients, the lidocaine levels ranged from 0.6 to 1.9 microgram/ml at varying intervals. There was no correlation between the maximum dose of lidocaine (mg/kg) or rate of lidocaine delivered (mg/ml) with plasma levels of lidocaine. CONCLUSION: Despite variability, the serum levels of lidocaine remained well within safety limits during infusion of tumescent solution and the first hours of the procedure when infused in rates up to 200 mg/min with spinal needles and/or small diameter multiholed infusion cannulas.     

改良肿胀麻醉技术在大容量吸脂术中的临床应用

回顾性分析2019年6月-2021年8月广西南宁微美医疗美容门诊部收治的98例脂肪抽吸塑形患 者临床资料，所有患者麻醉方式为全身静脉麻醉联合低浓度改良利多卡因肿胀液分次注射，手术方式为系 列脂肪抽吸形体雕塑术。对肿胀液注射量、抽吸总量、抽吸脂肪量、并发症发生情况进行统计，并调查患者 的满意度。结果显示，肿胀液注射量为6200~10 820 ml，平均注射量为（8341.00±997.60）ml；抽吸总脂肪量 为3210~4758 ml，平均抽吸总脂肪量（3945.00±578.00）ml；小范围的抽吸区域局部高低不平3例，抽吸区域皮 下有血清肿形成3例，小范围皮肤坏死1例，二期愈合后留有色素沉着；患者满意度为93.75%。说明改良低浓度 大剂量的利多卡因肿胀液为大容量大范围脂肪抽吸术提供了安全保障，提高了吸脂对体型重塑的效果，患者满 意度高。     

吸脂术中大剂量使用利多卡因的血药浓度监测及意义

目的探讨作为局部麻醉剂的利多卡因在肿胀法脂肪抽吸术中的极限剂量是多少,既能达到良好的镇痛效果,又能安全地使用而不产生毒副作用。方法对14例大剂量使用低浓度利多卡因作为局麻药的脂肪抽吸术的术中和术后血清利多卡因浓度以免疫荧光测定法进行了动态监测,作出其时间-浓度曲线,并与临床表现相对照。结果在此类手术中,利多卡因在0.1mg/ml的浓度下,加入1/1百万～1/2百万肾上腺素,其用量可达35mg/kg 体重而血清高峰浓度仍在安全范围内,无中毒症状,既可减轻病人的疼痛,又可减少出血,提高安全性,增加脂肪抽吸量。结论本研究为肿胀法吸脂术中大剂量使用利多卡因的临床实践提供了理论依据。     

Plasma lidocaine levels and risks after liposuction with tumescent anaesthesia

BACKGROUND: It is common today to use tumescent anaesthesia with large doses of lidocaine for liposuction. The purpose of the present study was to evaluate lidocaine plasma levels and objective and subjective symptoms during 20 h after tumescent anaesthesia with approximately 35 mg per kg bodyweight of lidocaine for abdominal liposuction. METHODS: Three litres of buffered solution of 0.08% lidocaine with epinephrine was infiltrated subcutaneously over the abdomen in eight female patients during monitored intravenous (i.v.) light sedation. Plasma levels of lidocaine and signs of subjective and objective symptoms were recorded every 3 h for 20 h after liposuction. RESULTS: Lidocaine 33.2 +/- 1.8 mg/kg was given at a rate of 116 +/- 11 ml/min. Peak plasma levels (2.3 +/- 0.63 microg/ml) of lidocaine occurred after 5-17 h. No correlation was found between peak levels and dose per kg bodyweight or total amount of lidocaine infiltrated. One patient experienced tinnitus after 14 h when a plasma level of 3.3 microg/ml was recorded. CONCLUSION: Doses of lidocaine up to 35 mg/kg were sufficient for abdominal liposuction using the tumescent technique and gave no fluid overload or toxic symptoms in eight patients, but with this dose there is still a risk of subjective symptoms in association with the peak level of lidocaine that may appear after discharge.     

Effect of Subcutaneous Lidocaine Infiltration on Blood Loss Secondary to Corporal Lipoaspiration: A Prospective,Randomized, Double-Masked Clinical Trial

Background  

Lipoaspiration is one of the most frequently performed aesthetic surgical procedures worldwide. The use of tumescent solution containing lidocaine to infiltrate subcutaneous fat before surgery has been accepted as the standard of care for these procedures. Its objective is to diminish postoperative analgesic necessities and secondary blood loss, but its role in hematocrit reduction is not clear at this time. This study aimed to measure the effect of subcutaneous lidocaine infiltration on blood loss secondary to corporal liposuction.