不同硬膜外阻滞对患者异丙酚镇静效应的影响  

Effects of thoracic and lumbar epidural block on depth of propofol sedation

作　　者：钱江[1] 祝胜美[1] 项燕[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州市310003

出　　处：《中华麻醉学杂志》2011年第7期819-821,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同硬膜外阻滞对患者异丙酚镇静效应的影响。方法择期行肠癌根治术患者30例和胃癌根治术患者15例，年龄20～64岁，ASA分级I或Ⅱ级，采用随机数字表法，将肠癌根治术患者随机分为2组（n=15）：生理盐水对照组（I组）和腰段硬膜外阻滞组（Ⅱ组）；胃癌根治术患者为胸段硬膜外阻滞组（Ⅲ组）。I组和Ⅱ组于k2.3间隙行硬膜外穿刺置管，Ⅲ组于L9,10间隙行硬膜外穿刺置管，Ⅱ组和Ⅲ组硬膜外注射1．5％利多卡因15ml（包括试验量3ml）；I组给予等容量生理盐水。于硬膜外给药后12min时TCI异丙酚，血浆靶浓度4μg／ml。于输注异丙酚前记录硬膜外阻滞范围（阻滞脊神经数）；分别于输注异丙酚2、3、4、5min时采集动脉血样，测定血浆异丙酚浓度，同时记录各时间点TCI泵计算的异丙酚血浆浓度和BIS值。结果与I组比较，Ⅱ组和Ⅲ组BIS值降低（P〈0．05），血浆异丙酚浓度和异丙酚血浆计算浓度差异无统计学意义（P〉0．05）；与Ⅱ组比较，Ⅲ组BIS值降低，硬膜外阻滞范围较广（P〈0．05），血浆异丙酚浓度和异丙酚血浆计算浓度差异无统计学意义（P〉0．05）。结论胸段硬膜外阻滞强化患者异丙酚镇静效应的程度高于腰段硬膜外阻滞。Objective To evaluate the effects of thoracic and lumbar epidural block on the depth of propofol sedation. Methods Forty-five ASA Ⅰ or Ⅱ patients with stomach cancer （ n = 15） or colorectal cancer （ n = 30） aged 20-64 yr weighing 46-79 kg with body height 151-179 cm undergoing elective radical operation were enrolled in this study. The 30 patients with colorectal cancer were randomly divided into 2 groups （ n = 15 each） ： group control （group Ⅰ ） and group lumbar epidural group（group 11 ）. The 15 patients with stomach cancer received thoracic epidural block （group Ⅲ ）. Epidural block was performed at L2,3 interspace in groups Ⅰand Ⅱand at T9,10 interspace in group m After a test dose of 3 ml 1.5% lidocaine, a bolus of 1.5% lidocaine 12 ml （in groups Ⅱ and m） or 12 ml of normal saline （in group Ⅰ ） was injected into epidural space. Target-controlled in- fusion（TCI） of propofol was started at 12 min after epidural lidocaine. Target plasma concentration of propofol was set at 4 μg/ml. Fentanyl 4 μg/kg was injected iv as soon as the patients lost consciousness. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated. Radial artery was cannulated for direct BP monitoring and blood sampling. BIS value was monitored （Aspect Medical System）. The number of spi- nal sequent affected in the subarachnoid epidural anesthesia was counted before propofol TCI. Arterial blood sam- ples were collected at 2, 3, 4 and 5 min of propofol TCI for determination of plasma concentration of propofol （by HPLC ）. BIS value and plasma concentration of propofol calculated by TCI pump were recorded at 2,3,4 and 5 min of propofol TCI. Results The BIS values were significantly lower in groups Ⅱ and Ⅲ than in group Ⅱ and in group Ⅲ than in group Ⅱ There was no significant difference in plasma propofol concentration measured by HPLC and plasma concentration of propofol calculated by TCI pump. Conclusion The efficacy of thoracic

关 键 词：麻醉 硬膜外 二异丙酚 清醒镇静 

分 类 号：R614[医药卫生—麻醉学]