CAJ | 학술논문

目的：观察0.25%罗哌卡因复合0.5%利多卡因切口浸润对异丙酚-瑞芬太尼全凭静脉麻醉下乳腺癌改良根治术术中血流动力学、麻醉及镇痛药物使用量、苏醒期疼痛的影响，以及对术后芬太尼静脉自控镇痛（PCIA）效果的影响。方法40例择期行乳腺癌改良根治术的患者，随机分为两组。分别给予0.25%罗哌卡因＋0.5%利多卡因混合液（浸润组，n=20）或生理盐水（对照组，n=20）切口浸润后5min切皮。两组术中均为异丙酚-瑞芬太尼全凭静脉麻醉维持至术毕。记录诱导前（T0）、局部浸润前（T1）的平均动脉压（MAP）和心率（HR）；切皮（T2）及分离乳房后间隙（T3）过程中的MAP、HR峰值；记录术中异丙酚、瑞芬太尼总用量；记录拔管后5min的疼痛VAS评分以及苏醒期躁动Riker镇静-躁动（SAS）评分，以及术毕24h VAS评分和第1个24h内PCIA中芬太尼的用量以及按键次数。结果切皮与分离乳房后间隙时浸润组的MAP、HR峰值均明显低于对照组（P＜0.01或P＜0.05）。浸润组丙泊酚用量、瑞芬太尼用量、拔管后5min疼痛VAS评分、苏醒期SAS评分、第1个24h PCA中芬太尼用量及按键次数均明显低于对照组（P＜0.01或 P＜0.05）。结论0.25%罗哌卡因加0.5%利多卡因混合液切皮前切口浸润麻醉，能有效提高异丙酚-瑞芬太尼全凭静脉麻醉乳腺癌改良根治术血流动力学稳定性、减少术中异丙酚和瑞芬太尼用量、缓解苏醒期时的疼痛，并可减少患者术后24h内PCIA中芬太尼的用量。
목적：관찰0.25%라고잡인복합0.5%리다잡인절구침윤대이병분-서분태니전빙정맥마취하유선암개량근치술술중혈류동역학、마취급진통약물사용량、소성기동통적영향，이급대술후분태니정맥자공진통（PCIA）효과적영향。방법40례택기행유선암개량근치술적환자，수궤분위량조。분별급여0.25%라고잡인＋0.5%리다잡인혼합액（침윤조，n=20）혹생리염수（대조조，n=20）절구침윤후5min절피。량조술중균위이병분-서분태니전빙정맥마취유지지술필。기록유도전（T0）、국부침윤전（T1）적평균동맥압（MAP）화심솔（HR）；절피（T2）급분리유방후간극（T3）과정중적MAP、HR봉치；기록술중이병분、서분태니총용량；기록발관후5min적동통VAS평분이급소성기조동Riker진정-조동（SAS）평분，이급술필24h VAS평분화제1개24h내PCIA중분태니적용량이급안건차수。결과절피여분리유방후간극시침윤조적MAP、HR봉치균명현저우대조조（P＜0.01혹P＜0.05）。침윤조병박분용량、서분태니용량、발관후5min동통VAS평분、소성기SAS평분、제1개24h PCA중분태니용량급안건차수균명현저우대조조（P＜0.01혹 P＜0.05）。결론0.25%라고잡인가0.5%리다잡인혼합액절피전절구침윤마취，능유효제고이병분-서분태니전빙정맥마취유선암개량근치술혈류동역학은정성、감소술중이병분화서분태니용량、완해소성기시적동통，병가감소환자술후24h내PCIA중분태니적용량。
Objective To study the influences of incision infiltration with 0.25% ropivacaine mixed with 0.5%lidocaine on hemodynamic stability, intraoperative anesthetic requirements,recovery status, and on the effects of postoperative patient controlled analgesia(PCIA) with fentanyl in patients receiving radical mastectomy under total intravenous anesthesia with propofol and remifentanil. Methods Forty patients scheduled for radical mastectomy, were randomly divided into two groups:the infiltration group(n=20), patients received incision infiltration with 0.25%ropivacaine mixed with 0.5% lidocaine 5min before skin incision and the control group(n=20), patients received incision infiltration with normal saline instead. Anesthetic induction and maintenance were the same in the two groups. For both groups, hemodynamic changes and the total consumption of propofol and remifentanil during operation, Visual analog scale(VAS) scores at the time of 5min after extubation and sedation-agitation scale(SAS) scores during recovery stage were all recorded.The VAS scores 24h after operation, the total consumption of fentanyl and the number of keystrokes during the first 24h PCIA were also recorded. Results The peak values of MBP and HR measured at the time of skin incision and post- mammary space dissection, the VAS scores 5min after extubation, the SAS scores during recovery stage, the total consumption of fentanyl and the number of keystrokes during the first 24h PCIA were all significantly lower than those of the control group(P<0.01 or P<0.05). Conclusion Incision infiltration with 0.25%ropivacaine mixed with 0.5%lidocaine, which can be easily implemented during surgery, could stabilize hemodynamics, reduce anesthetic consumption, and alleviate postoperative pain in patients receiving radical mastectomy under total intravenous anesthesia with propofol and remifentanil.