两种麻醉方法在隆乳术中的应用

Clinical study on target-controlled-infusion of remifentanil for breast humping

目的:探讨靶控输注(TCI)瑞芬太尼、丙泊酚在经腋路小切口隆乳手术中的应用。方法:选择60例要求隆乳的女性,随机分为两组,Ⅰ组为靶控输注瑞芬太尼、丙泊酚,Ⅱ组为丙泊酚和氯胺酮。手术开始前,Ⅰ组诱导靶浓度:丙泊酚4μg/ml,瑞芬太尼3ng/ml,患者进入麻醉状态后维持靶浓度丙泊酚3μg,瑞芬太尼2ng/ml,术中根据患者体动反应及心律血压变化随时调整靶控浓度,Ⅱ组手术前静注丙泊酚2mg/kg,氯胺酮0.8mg/kg,然后持续泵注丙泊酚6mg/kg·min,术中根据患者体动反应间断推注氯胺酮0.5mg/kg术中监测血压、脉搏、呼吸、血氧饱和度,观察手术中及术后病人的不良反应,观察术后苏醒时间及离院时间。结果:Ⅰ组循环系统较Ⅱ组平稳,呼吸抑制较Ⅱ组明显,但SPO2多在95%左右,无明显统计学差异。术后苏醒时间及空向力恢复时间Ⅰ组较Ⅱ组短。术后恶心呕吐、苏醒期谵妄、头晕等不良并发症Ⅰ组较Ⅱ组少。结论:靶控输注丙泊酚瑞芬太尼与静脉泵注丙泊酚复合氯胺酮都可用于隆胸手术的麻醉,但靶控输注瑞芬太尼丙泊酚具有术中循环稳定,术后苏醒快定向力恢复时间短及术后并发症少等优点。

Objective Discussion on applying target controlled infusion （TCI）of remifentanil,propofor at breast humping by axilroad small incision. Methods 60 patients need breast humping were divided randomly into two groups： group I TCl remifentanil and propofol （n=30）, group Ⅱ iv propofol and katamine （n=30）. In group I anaesthesia was induced with the target concentration of propofol and remifentanyl were 4μg/ml and 3 ng/ml, respectively.The target concentration was modulated by hemodynamics and by body moving reaction during operation. In group II anaesthesia was induced with propofol 2mg/kg,katamine 0.8mg/kg, anaesthesia maintained by manual controlled infusion with propofol 6mg/kg ·min, and iv katamine 0.5mg/kg by body moving reaction during operation. During operation blood pressure,pulse,respiration and spo2 were monitored,adversed reaction was observed during intraoperative and postoperation, recovery time and leave hospital time were recored after operation. Results Group I circulation was more steady than group Ⅱ, respiratory depression group I was more obvious than group Ⅱ, but SPO2 still maintained 95%. While there was no statistical difference. Recovery time and leave hospital time group I shorter than group II and adverse reaction （nausea and vomitting,delirium,dizziness etc） group I was less. Conclusions Target controlled infusion of remifentanil,propofol and ketamine combined with propofol all useed for breast humping, but target controlled infusion of remifentanil,propofol has following advantage： circulation more steady, recovery time and leave hospital time shorter and less adverse reaction.