不同麻醉方法在乳腺癌改良根治术中的比较

Comparison of different anesthesia methods in modified radical mastectomy

目的对比静吸复合麻醉和全凭静脉麻醉下置入第三代喉罩机械通气用于乳腺癌改良根治术的特点。方法将60例择期单侧乳腺癌改良根治手术患者随机分成两组,静吸复合麻醉组(Ⅰ组),全凭静脉麻醉组(Ⅱ组),于麻醉前(基础)、插入喉罩1 min、切皮、腋窝清扫后5 min、拔出喉罩后1 min记录心率、平均动脉压、脉搏血氧饱和度,并记录术中及术后的相关并发症。结果两组麻醉时间、手术时间差异无统计学意义(P>0.05),停药至拔管时间静吸复合麻醉组要明显短于全凭静脉麻醉组(P<0.05),血流动力学平稳,均在正常波动范围内。术后恶心、呕吐、躁动率发生率静吸复合麻醉组高于全凭静脉麻醉组,但差异无统计学意义(P>0.05)。结论静吸复合麻醉和全凭静脉麻醉下置入第三代喉罩都可以安全地用于乳腺癌改良根治手术,术后并发症少,但前者拔管苏醒更快。

Objective To compare features of inhalation anesthesia and total intravenous anesthesia in the placement of third generation laryngeal mask （LM） mechanical ventilation for modified radical mastectomy. Methods 60 patients with unilateral breast cancer undergoing modified radical surgery were randomly divided into two groups： inhalation anes- thesia group （ I group）, and total intravenous anesthesia group （ ]1 group）. Heart rate, mean arterial pressure and satura- tion of pulse oximetry of the two groups were obaserved before anesthesia （base）, 1 rain after LM insertion, during inci- sion, 5 min after axillary dissection and 1 rain after pulling out LM. Intraoperative and postoperative complications of the two groups were also recorded. Results The two groups were not significantly different in the duration of anesthesia and operative time （P〉0.05）. From drug stop to extubation time the inhalation anesthesia group was significantly less than the total intravenous anesthesia group （P〈O.05）, with stable hemodynamics within the normal fluctuation range in both groups. Incidence rates of postoperative nausea, vomiting and restlessness were higher in the inhalation anesthesia group than in the total intravenous anesthesia group, but the differences was not significant （/9〉0.05）. Conclusion Under both inhalation anesthesia and total intravenous anesthesia third generation LM can be safely used in modified radical breast surgery with few complications, but in terms of extubation awakaing the former is much faster.