不同镇静方法在老年人硬膜外麻醉中的可行性及安全性研究  

The feasibility and reliability study of different conscious-sedation methods during epidural anesthesia in old patients

作　　者：吕建瑞[1] 杜中义[2] 张珍妮[1] 王庭国[1] 薛荣亮[1] 

机构地区：[1]西安交通大学第二医院麻醉科,西安710004 [2]韩城矿务局总医院

出　　处：《陕西医学杂志》2006年第2期214-217,共4页Shaanxi Medical Journal

摘　　要：目的:研究老年人硬膜外麻醉中不同镇静方法的安全性及可行性。方法:75例择期于硬膜外麻醉下行改良乳癌根治术的老年患者随机分为3组,氟杜组(A组,n=25),咪达唑伦组(B组,n=25)及丙泊酚组(C组,n=25)。分别于麻醉前、意识消失时、切皮时及消除腋窝淋巴结时测定BIS值,HR、SBP、DBP、RR、PetCO2及皮质醇浓度,及相应时点OAA/S评分。结果:A组BIS值处于睡眠状态,PetCO2、SBP、DBP与术前相比无显著变化(P>0.05),B组BIS值较A组下降明显(P<0.05),但伴有HR、SBP、RR、DBP降低(P<0.05)及PetCO2升高(P<0.05),C组BIS值处于麻醉状态,但HR、SBP、RR、DBP、皮质醇下降较术前及A、B两组明显(P<0.05)。结论:A组镇静方法不能消除术中应激及术后回忆,B组不能消除术中应激但无术后回忆,C组可完全消除术中应激及术后回忆,但伴有较明显的循环呼吸功能抑制。Objective： To study the feasibility and reliability of different conscious-sedation methods during epidural anesthesia in old patients. Methods： 75 cases subject to selective modified radical mastectomy under epidural anesthesia were randomly divided into 3 groups： Droperidol and pethidine group （group A, n = 25） , midazolam group （group B, n = 25）, propofol group （group C, n=25）. The HR, SBP, DBP, RR,PetCO2, concentration of hydrocortisone and BIS value were recorded and the OAA/S score were obtained respectively at the time of pre-anesthesia, conscious loss, operation initiation and axillary lymph node clearing. Results： In group A, the BIS value was in sleepy condition. PetCO2, SBP, DBP were not different compared with pre-operation （P〉 0. 05）. In group B, the BIS value decreased obviously compared with group A（P〈0. 05）, with HR, SBP, RR, DBP decreased （P〈0.05） and PetCO2 increased （P〈0. 05）. The BIS value of group C was in drugged state and HR, SBP, DBP, RR, concentration of hydrocortisone decreased more obviously than group A and B （P〈0. 05）. Conclusion： Group A could not preclude stress during operation and palinmnesis after operation. Group B could not preclude stress during operation but could preclude palinmnesis after operation was absent. Group C could preclude stress during operation and palinmnesis after operation completely, but the respiratory and circulatory inhibition was obvious.

关 键 词：麻醉 硬膜外 清醒镇静 老年人 硬膜外麻醉 安全性研究 镇静方法 PetCO2升高 改良乳癌根治术 OAA/S评分 呼吸功能抑制 

分 类 号：R614.42[医药卫生—麻醉学] R155[医药卫生—外科学]