瑞芬太尼和咪唑安定联合TCI复合肋间神经阻滞在隆乳术中的应用

Combined TCI application of remifentanil and midazolam plus intercostal block on augmentation mammoplasty

目的:探讨瑞芬太尼和咪唑安定联合TCI复合肋间神经阻滞用于隆乳手术的麻醉效果。方法:选择ASAⅠ～Ⅱ级拟行隆乳术的患者60例。在切皮前静脉输注咪唑安定0.05mg/kg,瑞芬太尼1μg/kg,术中同时开始泵入瑞芬太尼和咪唑安定。观察麻醉前、注射局麻药时、切皮前、手术30min、分离胸大肌后间隙时、停药时、停药后10min时的BIS值,MAP,HR,SpO2,ECG及镇静程度。所有患者行双侧胸3～5肋间神经阻滞。结果:与基础值相比,切皮前MAP降低(P<0.05),麻醉各时段HR的变化差异无统计学意义(P>0.05);麻醉中各时段BIS值均降低(P<0.01);切皮前,与基础值比较差异有显著意义(P<0.01);术中镇静、镇痛充分,镇静评分主要维持在3～5级。术中呼吸循环功能基本稳定。所有患者均对麻醉方法满意,并愿意在以后的类似手术中接受同样的麻醉方法。结论:瑞芬太尼和咪唑安定联合TCI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,是隆乳手术安全有效的麻醉方法。

Objective To investigate the combined TCI anesthetic effect of remifentanil and midazolam plus intercostal block on augmentation mammoplasty under local anesthesia. Methods There were 60 ASA grade Ⅰ～Ⅱ healthy female patients undergoing local anesthesia for elective augmentation mammoplasty.Midazolam 0.05mg/kg and remifentanil 1μg/kg were gave before cutting skin. These data of MAP,HR,BIS,HRV,SpO2,ECG and conscious-sedation level were observed before cutting skin,during local aneshtesia ,creating breast prostheses spaces behind musculuspectoralis major,30,120 mins during operation,withdral,10 mins after withdral. T3～T5 intercostal block was performed in all patients. Results Compared with basic value MAP decreased before cutting skin （P〈0.05）. The intraoperative HR had no obvious change （P〉0.05）,there was obvious difference of HRV value between before cutting skin and basic value （P〈0.01）,there was sufficient intraoperative conscious-sedation and analgesia,analgesia score was between 3 and 5. Conclusio n The combined TCI application of remifentanil and midazolam plus intercostal block is a safe,effective and ideal anesthetic method for augmentation mammaplasty under local aneathesia.It has advantages of excellent analgesia flabby musculus pectoralis major,little pain,rapid recovery,few side effects and no mental harm to patients.