持续硬膜外麻醉下行大量体外超声吸脂术的体会

Experience of External ultrasound assisted liposuction (EUAL) with large amount of volume under continuous epidural anesthesia

目的:评价持续硬膜外麻醉下行大量体外超声吸脂的疗效及安全性,并总结经验。方法:对15例肥胖患者在持续硬膜外麻醉下行体外超声吸脂术(其中腰腹部6例,大腿部9例),记录注入肿胀液量、吸出纯脂肪量,术前术中术后患者生命体征、血液成分变化,并观察并发症出现情况。结果:吸出脂肪量3300～4800ml,平均4100ml;11例短期内均出现血压下降、脉搏加快,皮肤、粘膜苍白,心悸,全身乏力,恶心、呕吐,纳差,眩晕等血容量不足的表现,查见红细胞、血红蛋白明显降低;术后恢复时间较局部肿胀麻醉者长,平均5天(以术后患者可自行下地行走,无明显不适为限),局部瘀紫严重,无感染、皮肤坏死、不平坦及松弛等其它并发症发生。结论:持续硬膜外麻醉下行大量体外超声吸脂需慎重,并要切实做好术前准备及术后处理。

Objective To evaluate the effect and safety of external ultrasound assisted liposuction （EUAL） with large amount of volume under continuous epidural anesthesia and to summarize the experiences. Methods 15 patients （abdomen-waist 6cases, thigh 9 cases）.were performed EUAL under continuous epidural anesthesia. We recorded tumescent liquid volumes and pure fat volumes as well as patients＂ life symptoms, blood component variations; also we observed the postoperative complications. Results Volume of sucked pure fat was 3300- 4800ml, average 4100ml; there were clinical manifestations of blood insufficiency in 11 patients, including lower blood pressure, rapid pulse, pale skin and general fatigue. We also found the decrease of erythrocyte and hemoglobin. Recovery time was longer than with tumescent anesthesia. （it spent 5 days for patients to walk by themselves）.There was severe bruise without other complications, such as infection, skin necrosis, unevenness and relaxation. Conclusion It should be cautious when performing EUAL with large amount of volume under continuous epidural anesthesia. Preoperative preparation and postoperative treatment should be done in earnest and carefully.