碳酸利多卡因硬膜外麻醉用于乳腺癌根治术的评价

Evaluation of Lidocaine Carbonate Epidural Block to Radical Operation of Mastocarcinoma

40例乳腺癌根治术患者 ,美国麻醉医师协会 (ASA)分级 ～ 级 ,随机分为 2组。第 1组硬膜外阻滞 +臂丛神经阻滞 ,应用 1.33%盐酸利多卡因 +0 .15 %盐酸地卡因 +1∶ 2 0万肾上腺素 ,硬膜外阻滞首量 12 m l,臂丛神经阻滞 2 0 ml;第 2组硬膜外阻滞 ,应用 1.73%碳酸利多卡因 +1∶ 2 0万肾上腺素 ,首量 15 ml。两组硬膜外阻滞选为 T4- 5间隙穿刺。首量给完后测定麻醉药效 ,并监测患者心率 (HR)、平均动脉压 (MAP)、血氧饱和度 (Sp O2 ) ,在麻醉前、后 30、 6 0、 12 0 min抽取动脉血作血气分析。结果显示 :第 2组麻醉的起效时间、阻滞完善时间要比第 1组短 (P<0 .0 1)。感觉神经阻滞节段数要比第 1组多 (P<0 .0 1) ;两组病人的 HR和 MAP,麻醉手术中改变不明显。麻醉后面罩给氧 ,两组病人的 Sp O2 、 Pa O2 增加 ,Pa CO2 有所下降 ,两组比较无统计学意义 ,但组内前后对照有显著差异 (P<0 .0 5 )。

Forty patients with mastocarcinoma receiving radical operation, ASA Ⅰ-Ⅱ, were divided randomly into two groups: The patients in the group Ⅰ were anesthetized with method of epidural block+brachial plexus block with anesthetics of lidocaine hydrochloride 1.33 %+dicaine hydrochloride 0.15 %+adrenalin 1:200000. The first volume for epidural block was 12 ml and brachial plexus block 20 ml; Epidural block was given to the patients in the group Ⅱ, lidocaine carbonate 1.73 %+adrenalin 1∶200000 was used and the first volume was 15 ml. T 4-5 was selected as puncture site for two groups. The anesthesia effect, anesthesia action time, complete block time and segments of block were measured and heart rates (HR), mean arterial blood pressure (MAP), blood oxygen saturation (SpO 2) were monitored and blood gas analysis was performed before anesthesia, at 30, 60 and 120 min after anesthesia. The results showed that the anesthesia action time, complete block time were shorter (P<0.01) and more segments of block (P<0.01) in group Ⅱ than in group Ⅰ. HR and MAP changed slightly in two groups during anesthesia. SpO 2and PaO 2 were increased and PaCO 2 decreased after oxygen supply with mask. Those parameters showed no significant difference (P<0.05) between groups but significant within each group. It was concluded that Lidocaine carbonate epidural block demonstrates better anesthesia effect and more safety when used to radical operation of mastocarcinoma.