静脉镇静镇痛复合肋间神经阻滞用于隆乳手术的临床观察

Clinical observation of intravenous sedation/analgesia plus intercostal block in augmentation mammaplasty

目的:观察静脉镇静镇痛复合肋间神经阻滞用于隆乳术的麻醉效果。方法:共60例行择期隆乳术的健康女性病人,随机采用负荷剂量后持续输注咪唑安定-芬太尼(M-F组,n=30)或咪唑安定-芬太尼-氯胺酮(M-F-K组,n=30)的方法,调整注速维持镇静深度在改良的OAA/S评分2～3分。所有病人行双侧T2～T7肋间神经阻滞。结果:两组病人术中呼吸循环功能稳定,镇静镇痛效果满意,以M-F-K组更为理想。两组病人均在停药后4～12min内清醒,时间无明显差别。术后24h随访所有病人均无术中记忆,对麻醉方法满意。结论:静脉镇静镇痛复合肋间阻滞具有镇痛良好,胸大肌松弛,病人痛苦小、恢复快、并发症少、无精神创伤等优点,是适合隆乳手术简单、安全有效的理想麻醉方法,以M-F-K镇静镇痛的效果更加理想。

Objective To observe the effect of sedation/analgesia plus intercostal block on augmentation mammaplasty. Methods In 60 healthy female patients undergoing elective augmentation mammaplasty, Midazolam-Fentanyl （group M-F, n =30） or Midazolam-Fentanyl- Ketamine （group M-F-K, n =30） were stochastically continously infused after a bolus dose of each drug, and the infusing rate was adapted to maintain the improved OAA/S to a score of 2 to 3. T2-T7 intercostal block was performed in all patients. Results Stabile circulation/respiration and sufficient sedation/analgesia, which was more satisfied in group M-F-K, reached in all patients intraoperatively. All patients became conscious in 4-12 minutes after drug infusion stopped, and there was no significant difference between the two groups. On postoperative visite at the 24th hour after the surgery, no intraoperative recall remained in all patients, and they were all satisfied with our methods. Conclusion Intravenous sedation/analgesia plus intercostal block is a simple, safe, effective and ideal anesthetic method for augmentation mammaplasty. 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.