乳腺多发性肿物Mammotome微创旋切术局部浸润麻醉与静脉麻醉的对照研究

Comparative research of applying local infiltration anesthesia and intravenous anesthesia in Mammotome minimal invasive system for multiple breast lumps excision

目的分析乳腺后间隙局部浸润麻醉与静脉麻醉用于乳腺多发性肿物Mammotome微创旋切术临床效果，以指导临床选择应用。方法将2013年7月-2015年9月在我院住院治疗的680例乳腺多发性肿物行微创旋切术的患者，按麻醉方式分为试验组（静脉麻醉）和对照组（乳腺后间隙局部浸润麻醉），每组340例，比较并分析两组的麻醉效果及术前、术中和术后血氧饱和度（SpO2）、平均动脉压（MAP）和心率（HR）、麻醉的不良反应发生率、患者对手术的满意度和耐受度等。结果两组麻醉成功率均为100．00％，试验组术中、术后SpO2与对照组比较，差异有高度统计学意义（P〈0．01），术中MAP、HR与对照组比较，差异有高度统计学意义（P〈0．01）。试验组患者的满意度和耐受度高，不良反应发生率低，与对照组比较，差异均具有高度统计学意义（P〈0．01）。结论乳腺多发性肿物微创旋切术采用两种麻醉方法均可以达到完成手术的麻醉效果，且安全可行，各有优势，静脉麻醉患者的满意度和耐受度较高，临床上可根据患者不同的病例特点，选取合适的麻醉方式。

Objective To compare and analyze the clinical effects of the local infiltration anesthesia and the intravenous anesthesia applied in Mammotome minimally invasive surgery in the treatment of breast multiple lumps for guid- ing the anesthesia selection in clinic. Methods According to the method of anesthesia, 680 cases of breast multiple lumps patients with minimally invasive surgery in our hospital from July 2013 to September 2015 were divided into the experimental group, which underwent the intravenous anesthesia, and the control group, which underwent the local infiltration anesthesia. There were 340 cases in each group. The preoperative, intraoperative and postoperative parameters including the anesthesia efficacy, the blood oxygen saturation（SpO2）, the mean arterial pressure（MAP）, the heart rate（HR）, and the incidence of adverse reactions of anesthesia, as well as the satisfaction degree and the tolerance degree of patients, were compared between the two groups. Results The successful anesthesia rate of two group was 100.00%, statistically significant differences were observed in the intraoperative and postoperative SpO2（P〈0.01）, there was significant difference in the intraoperative MAP and HR between the experimental group and the control group （P〈0.01）. Higher satisfaction degree and tolerance degree as well as lower incidence of adverse reactions of anesthesia were occurred in the experimental group compared with the control group （P〈0.01）. Conclusion Good anesthetic effects are achieved to complete the surgery by both anesthetic methods applied in Mammotome minimally invasive surgery in the treatment of breast multiple lumps. Both anesthetic methods are safe and feasible, with different advantages for each method. The patients undergone the intravenous anesthesia display higher satisfaction degree and tolerance degree. Appropriate anesthesia method can be selected according to the characters of individual patients in clinic.