摘要
目的介绍静脉镇静镇痛技术在局部麻醉隆乳术中的应用效果和体会.方法将606例ASAⅠ、Ⅱ级隆乳术患者分为四组,分别采用负荷剂量后持续输注异丙酚-芬太尼（P-F组,n=56）、咪唑安定-芬太尼（M-F组,n=130）、异丙酚-芬太尼-氯胺酮（P-F-K组,n=68）或咪唑安定-芬太尼-氯胺酮（M-F-K组,n=352）复合液的给药方法,调整注速维持镇静深度在改良的警觉/镇静评分2或3分.结果四组患者术中的镇静镇痛效果均满意,呼吸循环功能基本稳定,均在停药3～10min后清醒,但P-F-K组和M-F-K组患者的术中疼痛发生率及程度显著低于P-F组和M-F组.术后随访所有患者均对麻醉效果满意,仅P-F组和P-F-K组分别有11例和5例患者有模糊术中记忆.结论镇静镇痛技术是适用于隆乳局部麻醉手术简单、安全有效的理想麻醉方法,复合使用小剂量氯胺酮能明显减少术中疼痛的发生率,其中以咪-芬-氯复合镇静镇痛的术中疼痛和记忆发生率最低,程度最轻,是适于该手术的最佳镇静镇痛方法.
Objective To report the effect and experience of applying intravenous sedation/analgesia technique in augmentation mammaplasty under local anesthesia.Methods 606 ASA patients under went grade Ⅰ、Ⅱ augmentation mammaplasty were divided into four groups,Propofol-Fentanyl （Group P-F,n=130） or Midazolam-Fentanyl-Ketamine（Group M-F-K,n=352） was respectively continuously infused in different group after a bolus dose of each drug,and the infusing rate was adapted to maintain the improved observer＇s assessment of alertness/sedation scale（OAA/S） to a score of 2 to 3.Results In the four groups,sufficient intraoperative sedation/analgesia reached and patients were in stabile circulation and respiration intraoperatively on the whole,all patients became conscious in 3-10 minutes after drug infusion stopped,but the incidence and the degree of intraoperative pain in Group P-F-K and Group M-F-K were remarkably lower than that in Group P-F and Group M-F.On postoperative visite after the surgery,all patients were satisfied with our methods and only faint intraoperative recalls were found in 11 P-F group and 5 P-F-K group patients.Conclusion Sedation/analgesia is a simple,safe,effective and ideal technique for augmentation mammaplasty under local anesthesia.The incidence of intraoperative pain could be obviously reduced by combination of small dose ketamine.Of the four methods we used,M-F-K is the optimal method for this operation due to its lowest incidence and degree of intraoperative pain and recalls.
关键词
镇静
镇痛
局部麻醉
隆乳术
Sedation
Analgeda
Local anesthesia
Augmentation mammaplasty
