保留自主呼吸快通道静脉全身麻醉在乳腺良性肿瘤切除中的应用

目的探讨保留自主呼吸快通道静脉全身麻醉在乳腺良性肿瘤切除术中的应用。方法选择乳腺良性肿瘤切除患者60例,随机分为两组,A组:使用1%盐酸利多卡因沿乳腺后间隙进行局部浸润麻醉。B组:静脉缓慢推注0.3mg/kg氯胺酮,1mg/kg利多卡因,0.15μg/kg舒芬太尼,然后将氯胺酮丙泊酚按照体积比1:10进行混合,按照丙泊酚4~6 mg/(kg·h)的速度泵注。结果 A组患者的T1、T2、T3时SBP、DBP、HR较T0有明显的升高,与T0相比差异具有统计学意义(P0.05)。T1、T2、T3时SBP、DBP、HR组内相比差异无统计学意义(P0.05)。B组T1时SpO2有所下降,与T0、T2、T3相比差异具有统计学意义(P0.05),T0、T1、T2、T3的SBP、DBP、HR平稳。A组患者的麻醉镇痛效果差,患者的满意度低,与B组相比差异具有统计学意义(P0.05)结论舒芬太尼,丙泊酚联合亚麻醉剂量的氯胺酮在保留自主呼吸的快通道静脉全身麻醉在乳腺良性肿瘤切除术中具有镇静镇痛完善,对循环和呼吸影响轻微,术后镇痛完善等优点。

Maintaining spontaneous respiration during fast -track intravenous general anesthesia in the resection of breast benign tumor

Objective To investigate the application of maintaining spontaneous respiration during fast - track intravenous general anesthesia in the resection of breast benign tumor. Methods 60 patients who were about to have breast benign tumor removed were randomly divided into two groups. Group A： 1% lidocaine hydrocldoride was used for local infiltration anesthesia along the retrobreast space. Group B ： 0.3 mg/kg ketamine, 1 mg/kg lidocaine, and 0. 15 mu g/kg sufentani were administered slowly for intravenous injection, then ketamine was mixed with propofol in a volume mixing ratio of 1：10, and delivered with pumps at the speed of 4 -6mg propofol/（kg,h）. Results Group A： SBP, DBP and HR in T1 ,T2 and T3 were ohvioualy evaluated, which were significantly different from those in To, （ P 〈 0.05 ）. There was no statistically significant difference in SBP, DBP and HR of T1, T2 and T3 between groups （ P 〉 0.05）. Group B ： SpO2 decreased in T1 to some degree, showing statistically significant difference form those in T0, T2 and T3 （ P 〈 0.05）. SBP, DBP and HR in T0 , T1 , T2 and T3 were stable. In group A, analgesic effects were poor and patient satisfaction was low, which were statistically significant different from those in group （P 〈 0.05 ）. Conclusions In the resection of breast benign tumor, maintaining spontaneous respiration during fast - track intravenous general anesthesia with sufentaml, propofol plus subanesthetic doses of ketamine has perfect sedative and analgesic effects, little impact on blood circulation and respiration, and better postoperative analgesic effects.