中原医刊
中原醫刊
중원의간
CENTRAL PLAINS MEDICAL JOURNAL
2008年
7期
24-26
,共3页
小剂量氯胺酮%假体丰胸%浸润麻醉
小劑量氯胺酮%假體豐胸%浸潤痳醉
소제량록알동%가체봉흉%침윤마취
Small dose ketamine%Local anesthesia%Implant augmentation mammaplasty
目的 介绍静脉复合小剂量氯胺酮在局部浸润麻醉假体丰胸手术中的临床应用效果.方法 将300例要求假体丰胸的患者,ASAⅠ～Ⅱ级,平均分成三组,每组100例,分别采用负荷剂量后,开始局部浸润麻醉;在分离胸大肌前,分别静脉注射A组芬太尼、B组丙泊酚和C组氯胺酮,保证患者无明显体动及手术顺利进行,维持镇静深度在改良的警觉/镇静平分2或3分.结果 三组患者手术中的镇静镇痛效果均满意,呼吸及循环功能基本稳定,术后苏醒基本正常,C组患者术中的疼痛发生率及程度显著低于A组和B组.术后随访全部患者均对麻醉效果满意,A组和B组部分患者对手术有模糊记忆.结论 复合小剂量氯胺酮的镇静镇痛技术是适合局部麻醉下假体丰胸手术简单、安全有效的理想的麻醉方法,能够明显减少术中疼痛的发生率,其中C组术中疼痛和记忆发生率最低,程度最轻,是适合该手术的最佳镇静镇痛方法.
目的 介紹靜脈複閤小劑量氯胺酮在跼部浸潤痳醉假體豐胸手術中的臨床應用效果.方法 將300例要求假體豐胸的患者,ASAⅠ～Ⅱ級,平均分成三組,每組100例,分彆採用負荷劑量後,開始跼部浸潤痳醉;在分離胸大肌前,分彆靜脈註射A組芬太尼、B組丙泊酚和C組氯胺酮,保證患者無明顯體動及手術順利進行,維持鎮靜深度在改良的警覺/鎮靜平分2或3分.結果 三組患者手術中的鎮靜鎮痛效果均滿意,呼吸及循環功能基本穩定,術後囌醒基本正常,C組患者術中的疼痛髮生率及程度顯著低于A組和B組.術後隨訪全部患者均對痳醉效果滿意,A組和B組部分患者對手術有模糊記憶.結論 複閤小劑量氯胺酮的鎮靜鎮痛技術是適閤跼部痳醉下假體豐胸手術簡單、安全有效的理想的痳醉方法,能夠明顯減少術中疼痛的髮生率,其中C組術中疼痛和記憶髮生率最低,程度最輕,是適閤該手術的最佳鎮靜鎮痛方法.
목적 개소정맥복합소제량록알동재국부침윤마취가체봉흉수술중적림상응용효과.방법 장300례요구가체봉흉적환자,ASAⅠ～Ⅱ급,평균분성삼조,매조100례,분별채용부하제량후,개시국부침윤마취;재분리흉대기전,분별정맥주사A조분태니、B조병박분화C조록알동,보증환자무명현체동급수술순리진행,유지진정심도재개량적경각/진정평분2혹3분.결과 삼조환자수술중적진정진통효과균만의,호흡급순배공능기본은정,술후소성기본정상,C조환자술중적동통발생솔급정도현저저우A조화B조.술후수방전부환자균대마취효과만의,A조화B조부분환자대수술유모호기억.결론 복합소제량록알동적진정진통기술시괄합국부마취하가체봉흉수술간단、안전유효적이상적마취방법,능구명현감소술중동통적발생솔,기중C조술중동통화기억발생솔최저,정도최경,시괄합해수술적최가진정진통방법.
Objective To report the effect of applying intravenously small dose ketamine in implant augmentation mammaplasty under anesthesia.Methods Three hundred cases with ASAⅠ-Ⅱ were randomly divided into three groups,100 cases in each group.Local anesthesia was performed after a bolus dose of midazlam and fentanyl.Before the dissecting of pectoralis major,fentanyl was given to group A,propofol to group B and ketmine to group C.The three groups were adapted to maintain the improved observen's assessment of alertness/sedation scale(OAA/S)to a score of 2 to 3.Results In the three groups,sufficient intraoperative sedation/analgesia reached and patients were in stabile circulation and respiration intraoperatively on the whole, all patients became conscious in 2 - 8 minutes after operation, but the incidence and the degree of intraoperative pain in group C was remarkably lower and milder than that in group A and group B. On postoperative visite after the surgery, all patients were satisfied with our methods and only faint intraoperative recalls were found in some patients in group A and group B. Conclusion Sedation/analgesia by combination of small dose ketamine is a simple, safe, effective and ideal technique for augmentation mammaplasty under local anesthesia.The incidence of intraoperative pain could be obviously reduced. Of the three methods we used, group C is the optimal method for this operation due to its lowest incidence and degree of intraoperative pain and recalls.
