乳腺癌合并原发性高血压患者进行乳腺癌改良根治术的麻醉方法研究

doi:10.3877/cma.j.issn.1673-5250.2012.06.022

目的

探讨对乳腺癌合并原发性高血压患者进行乳腺癌改良根治术时，麻醉方法的安全性及有效性。

方法

选择2012年1月至7月，拟于本院接受择期乳腺癌改良根治术，并确诊合并原发性高血压的60例女性乳腺癌患者为研究对象。将其随机分为喉罩(L)组(n＝60)和气管插管(T)组(n＝60)，快速全身麻醉诱导后分别置入喉罩或插入气管导管。记录两组各时段平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO₂)、脑电双频谱指数(BIS index)及术中全身麻醉药物的用量，同时观察及比较术后并发症的发生情况(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书)。

结果

两组患者年龄、体重、手术持续时间等比较，差异无统计学意义(P>0.05)。L组置入喉罩及拔出喉罩前、后MAP，HR变化比较，差异无统计学意义(P>0.05)；T组气管插管和拔管前、后MAP，HR变化比较，差异均有统计学意义(P<0.05)。L组全身麻醉药用量明显少于T组，差异有统计学意义(P<0.05)；术后苏醒时间T组较L组长，差异有统计学意义(P<0.05)；术后咽喉不适及呛咳发生率T组明显高于L组，差异亦有统计学意义(P<0.05)。

结论

全身麻醉采用喉罩通气对循环影响小，麻醉药用量少，对气管刺激损伤小，是原发性高血压患者行乳腺癌手术较理想的麻醉方法。

关键词: 喉罩, 气管插管, 舒芬太尼, 丙泊酚, 原发性高血压, 乳腺癌, 手术

Objective

To study the safety and efficacy methods of anesthesia in modified radical mastectomy for breast cancer patients with essential hypertention.

Methods

From January to July 2012, a total of 60 cases patients in elective modified radical mastectomy for breast cancer with essential hypertention were randomly divided into 1aryngeal mask airway(LMA) group (L group, n=30) and tracheal intubation group (T group, n=30). After rapid induction were inserted into the endotracheal tube or laryngeal mask; mean arterial pressure(MAP), heart rate(HR), pulse oxygen saturation(SpO₂), bispectral index(BIS index)etc.were analyzed by statistical anlysis method. Informed consent was obtained from all participants.

Results

L group homed and pulled out laryngeal mask of MAP and HR had no significant differences (P>0.05). Before and after T group tracheal intubation and extubation, MAP and HR were significantly different (P<0.05), dosages of anesthetic in L group were less than that in T group (P<0.05), postoperative recovery time of L group was much shorter than that in T group (P<0.05). Incidences of throat irritation and cough in T group were significantly higher than those in L group (P<0.05).

Conclusions

Effects on the circulation is minimal by LMA anesthesia, with less anesthetic, minimal stimulation of airway damage, which is an ideal breast cancer surgery anesthesia to essential hyperatention patients.

Key words: laryngeal mask, tracheal intubation, sufentanyl, propofol, essential hypertention, breast cancer, surgery

表1 两组一般临床资料比较(±s)

Table 1 Comparison of general clinical data between two groups(±s)

组别	n	年龄(岁)	体重(kg)	手术时间(h)
L组	30	65.32±13.18	50.67±11.23	1.26±0.13
T组	30	63.12±12.45	52.36±16.10	1.42±0.34
t	?	0.65	－0.47	－2.41
P	?	>0.05	>0.05	>0.05

表1 两组一般临床资料比较(±s)

Table 1 Comparison of general clinical data between two groups(±s)

组别	n	年龄(岁)	体重(kg)	手术时间(h)
L组	30	65.32±13.18	50.67±11.23	1.26±0.13
T组	30	63.12±12.45	52.36±16.10	1.42±0.34
t	?	0.65	－0.47	－2.41
P	?	>0.05	>0.05	>0.05

表2 两组平均动脉血压、心率比较(±s)

Table 2 Comparison of mean arterial pressure, heart rates between two groups(±s)

组别	n	时段	MAP(mm Hg)	HR(次/min)
T组	30	术前	120.40±14.92	83.72±14.15
?	?	诱导后即刻	100.02±15.71	74.20±13.29
?	?	插管后	131.21±13.15	89.35±12.22
?	?	拔管前	112.13±13.14	80.23±13.29
?	?	拔管后	132.24±11.52	94.20±12.67
L组	30	术前	119.76±12.91	79.13±10.63
?	?	诱导后即刻	99.56±12.02	71.83±9.86
?	?	插管后	110.11±10.27	76.65±9.78
?	?	拔管前	111.04±9.98	75.13±10.37
?	?	拔管后	118.52±10.92	78.38±10.18

表2 两组平均动脉血压、心率比较(±s)

Table 2 Comparison of mean arterial pressure, heart rates between two groups(±s)

组别	n	时段	MAP(mm Hg)	HR(次/min)
T组	30	术前	120.40±14.92	83.72±14.15
?	?	诱导后即刻	100.02±15.71	74.20±13.29
?	?	插管后	131.21±13.15	89.35±12.22
?	?	拔管前	112.13±13.14	80.23±13.29
?	?	拔管后	132.24±11.52	94.20±12.67
L组	30	术前	119.76±12.91	79.13±10.63
?	?	诱导后即刻	99.56±12.02	71.83±9.86
?	?	插管后	110.11±10.27	76.65±9.78
?	?	拔管前	111.04±9.98	75.13±10.37
?	?	拔管后	118.52±10.92	78.38±10.18

表3 两组术后并发症发生率、拔管时间及术中舒芬太尼和丙泊酚的用量比较[n(%)，±s]

Table 3 Comparison of rates complications，extubation time and incidence of throat irritation and cough between two groups [n(%)，±s]

组别	n	并发症发生率		拔管时间(min)	舒芬太尼用量(μg)	丙泊酚用量(mg)
组别	n	拔管时呛咳	咽喉部不适	拔管时间(min)	舒芬太尼用量(μg)	丙泊酚用量(mg)
L组	30	1 (3.33)	18(60.00)	5.33±1.45	28.00±3.33	308.00±10.21
T组	30	4(13.33)	21(70.00)	14.36±5.78	44.00±3.56	410.00±12.05
χ²/t	?	－0.78	－9.53	－8.31	－17.1	－35.7
P	?	<0.05	<0.05	<0.05	<0.05	<0.05

表3 两组术后并发症发生率、拔管时间及术中舒芬太尼和丙泊酚的用量比较[n(%)，±s]

Table 3 Comparison of rates complications，extubation time and incidence of throat irritation and cough between two groups [n(%)，±s]

组别	n	并发症发生率		拔管时间(min)	舒芬太尼用量(μg)	丙泊酚用量(mg)
组别	n	拔管时呛咳	咽喉部不适	拔管时间(min)	舒芬太尼用量(μg)	丙泊酚用量(mg)
L组	30	1 (3.33)	18(60.00)	5.33±1.45	28.00±3.33	308.00±10.21
T组	30	4(13.33)	21(70.00)	14.36±5.78	44.00±3.56	410.00±12.05
χ²/t	?	－0.78	－9.53	－8.31	－17.1	－35.7
P	?	<0.05	<0.05	<0.05	<0.05	<0.05

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Methods of Anesthesia in Modified Radical Mastectomy for Breast Cancer Patients With Essential Hypertention

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Methods of Anesthesia in Modified Radical Mastectomy for Breast Cancer Patients With Essential Hypertention