高位硬膜外麻醉联合喙突下臂丛神经阻滞在乳腺癌根治术中的应用(附122例分析)

The apply of high position epidural anesthesia combine with subcoracoid brachial plexus in mammary cancer radical operation

目的比较高位硬膜外麻醉联合喙突下臂丛神经阻滞与单用硬膜外麻醉在乳腺癌根治中的麻醉效果与安全性。方法乳腺癌根治手术病人122例,随机分为两组,Ⅰ组:单用硬膜外;Ⅱ组:高位硬膜外麻醉联合喙突下臂丛神经阻滞;每组61例。结果两组病人手术开始切皮时都能达到满意的效果,但术中分离切口上缘和清扫腋窝淋巴结时,Ⅱ组麻醉效果优于I组(P<0.01);两组未使用辅助药的病人中,硬膜外注药前、麻醉初量后15分钟、30分钟,BP、HR及SPO2无明显变化(P>0.05);使用辅助药后5分钟、10分钟时,BP及SPO2均有不同程度的下降、HR减慢,与使用辅助药前相比有显著性差异(P<0.01)。结论乳腺癌根治手术采用高位硬膜外联合喙突下臂丛神经阻滞麻醉效果明显优于单纯硬膜外阻滞,术中使用辅助药的概率小,对BP、HR及SPO2的影响小,安全性更高。

Objective To compare with the effect and safety in mammary cancer radical cure operation between high position epidural and epidural combine with subcoracoid brachial plexus block anesthesia. Method 122 mammary cancer radical operation atients divided into two groups on random. Group Ⅰ ： High position epidural anesthesia simply. Group Ⅱ ： High position epidural combine with subcoracoid brachial plexus block. 61 cases in each group. Results Satisfy anesthetic effect in two groups＇ patients at the beginning of operation, but the anesthetic effect of group Ⅱ patients at process of separating superior edge of incision and clearing axillary lymphnodes is better than group Ⅰ （P〈0. 0 1）. Without using adjuvant, before epidural injection, 15 and 30 minutes after using the first dosage, there is not obvious change of BP. HR and SPO2. But 5 minutes and 10 minutes after using adjuvant, BP and SPO2, reduced in a certain extent, HR decreased, compare with using adjuvant before, there is significant difference （P〈0.01）. Conclusion The effect of high position epidural anesthesia combine with sub coracoid brachial plexus block is much better than epidural anesthesia simply in mammary cancer radical operation. There is less probability of using adjuvant during operation, less influence to BP. HR and SPO2, and more safety.