肋间神经阻滞、静脉麻醉、肋间神经阻滞复合静脉咪达唑仑用于乳腺肿块切除术中镇痛效果的比较

Compare intercostal nerve block,intravenous anesthesia,intercostal nerve block and intravenous midazolam in lumpectomy

目的比较肋间神经阻滞、静脉麻醉、肋间神经阻滞复合静脉咪达唑仑用于乳腺区段术中镇痛效果、不良反应、对呼吸的影响以及总体麻醉效果评价。方法随机将患者分为3组,每组50人,A组应用0.375%罗哌卡因行肋间神经阻滞;B组应用静脉麻醉;C组应用0.375%罗哌卡因行肋间神经阻滞复合静脉咪达唑仑。比较3种麻醉方法在乳腺区段术中的镇痛结果、不良反应、对呼吸的影响以及总体麻醉效果评价。结果A组患者术中镇痛效果满意率88%,无气胸、恶心呕吐、无呼吸抑制;B组患者术中镇痛效果满意率98%,42%患者术中呼吸抑制需面罩加压给氧,术后恶心呕吐率12%;C组患者术中镇痛效果满意率98%,无气胸、呕吐,2%患者有一过性的呼吸抑制需面罩加压给氧,由于咪达唑仑的顺行性遗忘性作用使得28%患者无手术记忆。结论乳腺肿块切除采用肋间神经阻滞复合静脉咪达唑仑镇痛效果好,麻醉管理方便,不良反应小,值得推广应用。

Objective Compare analgesic effect, side effects, influence on breath and evaluation of total anesthesia effect about the intercostal nerve block, Intravenous anesthesia, intercostal nerve block and intravenous midazolam in lumpectomy. Method Patients were divided into three groups randomly, each group of 50 people. Group A applied intercostal nerve block by 0. 375% ropivacaine. Group B applied the intravenous anesthesia technology. Group C applied intercostal nerve block by 0. 375 % ropivacaine and intravenous midazolam. Compare their analgesic effect, side effects, influence on breath and evaluation of total anesthesia effect. Results In group A, 88% cases achieve satisfied analgesic effect, all patients have not the pneumothorax, nausea and vomiting and respiratory depression, in group B 98% cases achieve satisfied analgesic effect, the incidence of respiratory depression with mask ventilation during the operation was 42%, the incidence of postoperative nausea and vomiting was 12%, in group C, 98% cases achieve satisfied analgesic effect, all patients had not the pneumothorax, nausea and vomiting, the incidence of respiratory depression with mask ventilation during the operation was 2 %0, 28 % cases had not operation memory under midazolam＇s direct lethe. Conclusion Intercostal nerve block by ropivacaine and intravenous midazolam are easy to get a better satified analgesia effect and the anaethesia management of group C is simple and has little side effects, that is worth promoted.