摘要
目的探索静脉镇静镇痛复合肋间神经阻滞用于局麻隆乳手术的麻醉效果。方法460例Ⅰ～Ⅱ级ASA,择期在局麻下行隆乳术,按输注的镇静镇痛药物不同分为丙泊酚-芬太尼-氯胺酮复合组(P-F-K组)87例,咪唑安定-芬太尼-氯胺酮复合组(M-F-K组)373例,均采用负荷剂量后持续输注相应镇静镇痛药物的方法,以改良的警觉/镇静(OAA/S)评分,2～3分为目标调整输注速度。所有患者行双侧T2～T6肋间神经阻滞。结果2组患者的术中镇静镇痛效果满意,少数患者在局麻药注射或/和分离胸大肌后间隙时出现不同程度疼痛,其中P-F-K组较为明显,在追加镇痛药物后缓解。术中呼吸循环功能基本稳定,但有31例患者出现轻度舌后坠。2组患者的清醒时间无明显差别,均在停药4～10min后清醒。术后24h随访,仅P-F-K组7例患者有非连贯性的模糊术中记忆。所有患者均对所用的麻醉方法满意,并愿意在以后的类似手术中接受同样的麻醉方法。结论镇静镇痛复合肋间神经阻滞具有镇痛良好,胸大肌松弛,患者痛苦小,恢复快,并发症少,无精神创伤等优点,是局麻隆乳手术简单、安全有效的理想麻醉方法,其中M-F-K镇静镇痛的效果更为理想。
Objective To report the effect of intravenous sedation/analgesia plus intercostal block on augmentation mammaplasty under local anesthesia.Methods 460 ASA grade I～II healthy female patients undergoing local anesthesia for elective augmentation mammaplasty were divided into Propofol-Fentanyl-Ketamine group (group P-F-K,n=87) and Midazolam-Fentanyl-Ketamine group (group M-F-K,n=373) according to different sedation & analgesia drugs infusion.After a bolus dose of Midazolam 0.05 mg/kg,Fentanyl 1 mg/kg and Ketamine 0.3 mg/kg,different sedation & analgesia drugs were continously infused in all patients,and infusing rate was adapted to maintain the improved observer's assessment of alertness/sedation scale (OAA/S) to a score of 2 to 3.T2～T6 intercostal block was performed in all patients.Results Sufficient intraoperative sedation/ analgesia reached in each group. Degrees of pain during local anesthesia or/and creating breast prostheses spaces behind musculus pectoralis major,which were obvious in group P-F-K and could be relieved by superaddition of analgetics,were found in minor patients.By and large,all patients were in stabile circulation and respiration intraoperatively, but slight glossocoma occurred in 31 patients.There was no significant different in awaking time between two groups,and all patients became conscious in 4～10 minutes after drug infusion stopped.Only noncontinuous faint intraoperative recalls were found in 7 group P-F-K patients on postoperative visite at the 24th hour after the surgery.All patients were satisfied with our methods and would like to accept the same anesthesia for samiliar surgery in future.Conclusion Intravenous sedation/analgesia plus intercostal block is a simple,safe,effective and ideal anesthetic method for augmentation mammaplasty under local anesthesia.It has advantages of excellent analgesia,flabby musculus pectoralis major,little pain,rapid recovery,few side effects and no mental harm to patients.M-F-K provides more perfect sedation/analgesia for this operation.
