不同浓度肾上腺素局麻液对真空辅助旋切手术的影响

The Effect of Different Concentration of Epinephrine Local Anesthesia Solution in Vacuum Assisted Circumcision Operation

摘要: 目的：观察不同浓度肾上腺素局麻混合液在麦默通真空旋切活检手术中的临床实际效果。方法：选择2018年1月至2020年1月我院收治入院的300例已行麦默通真空旋切活检术的乳腺肿瘤患者作为研究对象，分为三组，局麻混合液分别采用肾上腺素1 mg + 利多卡因200 mg + 生理盐水100 ml (即肾上腺素浓度1:10万作为实验组1)和肾上腺素0.2 mg + 利多卡因200 mg + 生理盐水100 ml (即肾上腺素浓度1:50万作为实验组2)以及利多卡因200 mg + 生理盐水100 ml (不加肾上腺素单纯麻药作为对照组)，每组各100例，比较三组的血压、心率变化情况、麻醉效果、术中出血量、手术时间、局部压迫时间、术后并发症等指标。结果：三组在血压、心率变化情况方面无明显差异(P > 0.05)；实验组麻醉效果、术中出血量、手术时间、压迫时间均优于对照组(P < 0.05)；实验组皮肤瘀斑和局部血肿发生率低于对照组，而皮肤坏死发生率高于对照组(P < 0.05)；不同肾上腺素浓度与术中出血量呈负相关(r = −0.76, P < 0.01)。结论：麦默通真空旋切活检手术过程中，局麻药中加入适量比例肾上腺素对患者血压和心率影响不明显，不仅能有效缩短手术时间，减少术中出血和总体并发症的发生，还能提高麻醉效果，增加患者就医体验的满意度。

Abstract: Objective: To observe the clinical effect of different concentrations of epinephrine local anesthesia mixture in MMT vacuum biopsy. Methods: From January 2016 to January 2020, the 300 breast tumor patients who had accepted MMT vacuum biopsy were selected as the study subjects. The mixtures of adrenaline 1 mg + lidocaine 200 mg + normal saline 100 ml (adrenaline concentration 1:100,000 as the experimental group) and adrenaline 0.2 mg + lidocaine 200 mg + normal saline 100 ml (adrenaline concentration 1:500,000 as the control group) were used respectively, 100 cases in each group, the changes of blood pressure, intraoperative hemorrhage, compression time and postoperative complications were compared between the two groups. Results: There was no significant difference in blood pressure between the two groups (P > 0.05). The anesthesia effect, intraoperative hemorrhage, operation time and compression time of the experimental group were better than those of the control group (P < 0.05); the incidence of ecchymosis and local hematoma in the experimental group was lower than that in the control group, while the incidence of skin necrosis was higher than that in the control group (P < 0.05); there was a negative correlation between different adrenaline concentrations and intraoperative hemorrhage (r = −0.76). Conclusion: In the process of MMT vacuum biopsy, the appropriate proportion of epinephrine in local anesthetics can effectively reduce the incidence of bleeding and complications, and the amount of bleeding is positively correlated with the concentration of epinephrine.