崔德壮　房亮　冯春林　李玉雯

[摘要]目的：探究丙泊酚在乳腺癌根治术联合背阔肌转移皮瓣乳房再造术中的应用效果。方法：选取2014年3月-2019年10月入院施行乳腺癌根治术联合背阔肌转移皮瓣乳房再造术治疗的患者80例作为研究对象，随机分为研究组及对照组，每组40例。研究组术中采用丙泊酚全凭静脉麻醉，对照组使用七氟醚吸入麻醉。比较两组手术及麻醉情况、血流动力学相关参数[心率（HR）、平均动脉压（MAP）及经皮脉搏血氧饱和度（SpO2）]，术后恶心呕吐（PONV）、术后并发症及相关不良反应发生情况。结果：研究组麻醉苏醒时间明显低于对照组，24h恢复质量评分明显高于对照组，差异有统计学意义（P<0.05）。兩组拔管时间、术中出血量比较差异无统计学意义（P>0.05）。研究组术中心率（HR）、平均动脉压（MAP）相比对照组变化更为稳定（P<0.05）。研究组术后并发症总发生率为12.50%，明显低于对照组的32.50%，差异有统计学意义（P<0.05）。研究组术后24h内PONV发生率明显低于对照组，差异有统计学意义（P<0.05）。研究组麻醉相关不良反应发生率为12.50%，与对照组（15.00%）比较差异无统计学意义（P>0.05）。结论：丙泊酚麻醉应用于乳腺癌根治术联合背阔肌转移皮瓣乳房再造术中患者血流动力学相关参数具有良好的稳定作用，可明显降低术后并发症发生率，且麻醉相关不良反应发生率较低，具有良好的应用价值。

[关键词]丙泊酚;七氟醚;乳腺癌根治术;背阔肌皮瓣;乳房再造术;血流动力学;并发症

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）09-0029-04

Application of Propofol in Breast Cancer Radical Mastectomy Combined with Breast Reconstruction with Latissimus Dorsi Myocutaneous Flap

CUI De-zhuang1，FANG Liang1，FENG Chun-lin1，LI Yu-wen2

（1.Department of Anesthesiology，Zibo First Hospital，Zibo 255200，Shandong，China;2.Department of Anesthesiology，Shandong Cancer Hospital，Jinan 250000，Shandong，China）

Abstract： Objective  To explore the clinical application effect of propofol in patients with breast cancer undergoing radical mastectomy combined with breast reconstruction with latissimus dorsi myocutaneous flap. Methods  A total of 80 patients undergoing radical mastectomy combined with breast reconstruction with extended latissimus dorsi myocutaneous flap in the hospital were enrolled as the research objects between March 2014 and October 2019. They were randomly divided into the study group and the control group， 40 cases in each group. The study group was given propofol for total intravenous anesthesia， while the control group was given sevoflurane for inhalation anesthesia. The differences in hemodynamic related parameters [heart rate （HR）， mean arterial pressure （MAP）， percutaneous pulse oximetry （SpO2）] and incidence of postoperative nausea and vomiting （PONV）， postoperative complications and related adverse reactions were compared between the two groups. Results  The recovery time of anesthesia in the study group was significantly lower than that in the control group， and the 24h recovery quality score was significantly higher than that in the control group （P<0.05）. There was no significant difference in extubation time and intraoperative bleeding between the two groups （P>0.05）. The changes of intraoperative heart rate （HR） and mean arterial pressure （MAP） in the study group were more stable than those in the control group （P<0.05）. The total incidence of postoperative complications in the study group was 12.50%， significantly lower than that in the control group （32.50%， P<0.05）. The incidence of PONV in the study group within 24 hours after operation was significantly lower than that in the control group （P<0.05）. The incidence of anesthesia related adverse reactions in the study group was 12.50%， which had no significant difference compared with the control group （15.00%，P>0.05）. Conclusion  Propofol anesthesia can effectively stabilize hemodynamic related parameters in patients undergoing radical mastectomy combined with breast reconstruction with latissimus dorsi myocutaneous flap， significantly reduce postoperative complications， with low incidence of anesthesia-related adverse reactions and good application value.

Key words： propofol; sevoflurane; radical mastectomy; latissimus dorsi myocutaneous flap; breast reconstruction; hemodynamics; complication

乳腺癌为当今社会女性高发生率的癌症，研究表明其病理过程为腺上皮组织细胞恶性增殖至浸润性癌症[1]。保乳术对于早期乳腺癌有良好的疗效，但中后期较常采用乳房切除术进行治疗。乳房切除后胸大肌缺失，胸部瘢痕增加，腋前壁形态消失。背阔肌皮瓣携带扇形肌肉组织，可较良好的对乳房切除部分进行覆盖，因此，利用背阔肌皮瓣进行乳房再造术为常见的乳房再造方法[2]。……