氯普鲁卡因高位硬膜外阻滞在乳癌根治术中的应用

Application of chloroprocain for higher epidural anesthesia in the radical mastectomy of breast cancer

目的对国产1%氯普鲁卡因行高位硬膜外阻滞在乳癌根治术中应用的有效性及安全性进行评估。方法60例择期行乳癌根治手术的患者,ASAⅠ～Ⅱ级,年龄23～71岁,体重40～71kg,随机分为观察组(n=30)和对照组(n=30)。T1～2或T2～3间隙穿刺,向头侧置管4～6cm,观察组注入1%氯普鲁卡因+1:20万肾上腺素5ml,对照组注入1%利多卡因+1:20万肾上腺素5ml,5min后,两组分别给予同类药18ml。观察项目:(1)麻醉起效时间、痛觉消失时间、痛觉恢复时间。(2)给药15min后麻醉阻滞范围。(3)呼吸循环改变:患者入室时、麻醉后10min、20min、30min、60min时HR、BP、RR、SPO2。(4)观察和记录两组患者可能出现的副作用,如头昏、倦怠、感觉异常、肌肉震颤、呼吸抑制。结果两组病人的麻醉起效时间分别为4.8±0.9min和5.4±1.1min(P>0.05),痛觉消失时间分别为12.2±2.3min和13.3±3.1min(P>0.05),痛觉恢复时间分别为49.2±1.45min和50.1±13.8min(P>0.05)。两组患者在麻醉前及给药后HR、BP、RR、SPO2各组数据间均无统计学意义(P>0.05)。两组患者头昏、肌肉震颤、呼吸抑制的发生率分别为1例(3.3%)和6例(20.0%)(P<0.05),观察组明显低于对照组。结论1%氯普鲁卡因行高位硬膜外阻滞在乳癌根治术中的应用其麻醉效果与1%利多卡因相同,但头昏、肌肉震颤、呼吸抑制的发生率明显低于后者。

Objective Considering 1% Lidocaine as the drugs control,to evaluate the effectiveness and safety of 1% domestic chloroprocaine for higher epidural anesthesia in radical mastectomy of breast cancer.Methods Sixty ASA Ⅰ or Ⅱpatients who aged 24- 71 yr weighing 40- 71kg undergoing elective radical mastectomy of breast cancer were divided randomly into observer group （n=30） and control group （n=30）. T1-2or T2-3interspace puncture, cephalad to the home of 4- 6cm.The observer group were injected with 1% chloroprocaine ＋1：200,000 adrenaline 5 ml,the control group were injected with 1% lidocaine ＋1：200,000 adrenaline 5ml,both were gave the same drugs 18ml after five minutes.Observing the two groups of patients：（1）The narcotic onset time,the pain free time, the pain recovery time.（2）The scope of anesthesia at the interval time of 15 minutes after taking the drugs. （3）The HR,BP,RR,SpO2 at the interval time of 10,20,30,60 minutes after patients were anesthesiaed.（4）Observe and record the possible side effects of the two groups of patients suffere＆Results The narcotic onset times for the two groups patients are 4.8＋0.9min and 5.4＋l.lmin respectively （P〉0.05）.The pain free times are12.2＋2.3min and 13.3＋3.1min respectively （P〉0.05）.The pain recovery times are 49.2＋14.Smin ahd 50.1＋13.8min respectively（P〉0.05）. The rates of the dizziness,muscle tremors,respiration inhibition for the two groups of patients are 1 case（3.3%）and 6 cases （20.0%） （P〈0.05）.The observer group was significantly lower than the control group.Conclusion The anesthetic effect of the application of l%chloroprocaine for higher epidural anesthesia in radical mastectomy of breast cancer as the same as 1% lidocaine.The observer group was significantly lower than the control group at rates of dizziness,muscle tremors,respiration inhibition.The 1% chlorprocaine can be used safely for higher epidural anesthesia .