关键词:  乳腺肿瘤；舒芬太尼；罗哌卡因；静脉麻醉；血气分析；保乳手术

Abstract:

Objective To compare the anesthetic effects between sufentanil based total intravenous anesthesia and epidural anesthesia with ropivacaine in conserving operation for breast cancer. Methods Thirty-eight ambulatory adult female patients in ASA ⅠorⅡphysical statuses scheduled for breast operation were randomly divided into two groups. Nineteen cases adopted sufentanil based total intravenous anesthesia (sufontanil group)and others were treated with ropivacaine based  epidural anesthesia(ropivacaine group). The systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR ),respiratory rate (RR),tidal volume (TV),oxyhemoglobin saturation (SpO2),pH,partial pressure of arterial carbon dioxide (PaCO2) and arterial oxygen pressure (PaO2)were detected  before anesthesia (t0),15 min after anesthesia (t1),the beginning of operation (t2), 1 h after anesthesia (t3),the end point of operation (t4).The application of ephedrine and atropine and the revive time were recorded. Results① Comparison in each group:compared with t0,SBP  at t1,t2,t3 and t4 points were decreased significantly(P<0.05);and DBP  at t1,t2 and t3 time points were decreased(P<0.05） in two groups. In ropivacaine group,HR showed a decline trend  at t1,t2 and t3 time pints compared with  t0 (P<0.05);and in sufentanil group,HR showed a decline trend at t1 and t3 compared with  t0 (P<0.05). Both in two groups,compared with t0,SpO2  showed no significant difference at four time points. At t3 and t4 time points,PaO2 was increased significantly(P<0.05),while pH was decreased(P<0.05). At t2 and t2 time points,PaO2 were increased significantly in ropivacaine group(P<0.05),and PaCO2 were increased significantly in two groups at t1,t2,t3 and t4 time points(P<0.05). Compared with t0,TV were increased at t2,t3 and  t4 in two groups,and TV was also increased in sufentanil group at t1,while RR were decreased significantly at t1,t2,t3 and t4 time points in two groups(P<0.05). ②Compared with  ropivacaine group: higher SBP and PaO2 were found in sufentanil group at t2 time point (P<0.05),and HR were also increased in sufentanil group at t2 and t3 time points. The rate of HuoNa’s levy in ropivacaine group was higher than that in sufentanil group. Other indexes were not significantly different. Conclusion  The two anesthesia methods have a similar blood gas analysis results;compared with epidural anesthesia with ropivacaine,sufentanil based total intravenous anesthesia shows a lower rate of complication and tiny homodynamic changes. Sufentanil can be used in breast conserving operation for breast cancer safely.

Key words: breast neoplasm;sufentanil;ropivacaine;intravenous anesthesia;blood gas analysis;breast conserving operation