腰段硬膜外阻滞对全凭静脉麻醉老年患者诱导及维持期丙泊酚用量的影响  

Effect of lumbar epidural block on the dosage of propofol during induction and maintenance of total intravenous anesthesia in elderly patients

作　　者：岳霞影[1] 吴晓晖 薛慧[1] 杨黎明[1] 陈文婷[1] 唐炜[1] Yue Xiaying;Wu Xiaohui;Xue Hui;Yang Liming;Chen Wenting;Tang Wei(Department ofAnesthesiology,Shuguang Hospital Afiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200021,P.R.China)

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海201203

出　　处：《老年医学与保健》2021年第5期1056-1059,共4页Geriatrics & Health Care

基　　金：国家自然科学基金青年科学基金项目(81603450);上海中医药大学预算内项目(2020LK047)。

摘　　要：目的在BIS监测下,测定腰段硬膜外阻滞对老年患者全凭静脉麻醉期间丙泊酚诱导剂量及维持剂量的影响。方法选择ASA Ⅰ~Ⅲ级,择期行腹腔镜结肠癌根治术的老年患者60例,随机为两组,单纯全麻组(G组,n=30)和腰段硬膜外阻滞复合全麻组(GE组,n=30)。麻醉诱导:TCI血浆浓度丙泊酚1 μg/mL,根据患者BIS值或意识消失情况,每3 min追加0.5 μg/mL,直至BIS低于60或意识消失,随后静脉注射舒芬太尼0.3 μg/kg、罗库溴铵0.6 mg/kg,给予肌松药3 min后行气管插管。麻醉维持:术中BIS值维持40~60之间,根据肌松监测和循环情况追加罗库溴铵和舒芬太尼。主要观察指标为丙泊酚诱导及维持剂量;次要观察指标为舒芬太尼和罗库溴铵用量;其他观察指标为术中心血管不良事件发生率和拔管时间。结果总计57例患者完成本研究,其中单纯全麻组(G组)28例,腰段硬膜外阻滞复合全麻组(GA) 29例。与G组相比,GE组丙泊酚诱导剂量(1.4±0.3 vs 2.1±0.4) mg/kg和维持剂量(4.1±1.2vs 7.9±1.4) mg/kg/h 比 G组低,差异有统计学意义(P<0.001);同时拔管时间比G组短(4.6±2.8 vs 9.5±3.5) min,差异有统计学意义(P<0.001);舒芬太尼用量(18.2±3.1 vs 31.7±5.8) μg;罗库溴铵用量(54.5±11.6 vs 68.3±14.9) mg,均比G组少,差异有统计学意义(P<0.05);术中心血管不良事件发生率也更低。结论腰段硬膜外阻滞可以减少老年腹腔镜结肠切除术患者全凭静脉麻醉时的丙泊酚诱导剂量(约1/3)和维持剂量(约1/2),同时也减少舒芬太尼和罗库溴铵用量,并且术中血流动力学更平稳、术后拔管时间更短。To determine the effect of lumbar epidural block on the induced dose and maintenance dose of propofol during total intravenous anesthesia in elderly patients.Methods Sixty elderly patients with ASAⅠ-Ⅲ grade who underwent elective laparoscopic radical resection of colon cancer were selected and randomly divided into two groups,simple general anesthesia group(G group,n=30)and lumbar epidural block combined general anesthesia group(GE group,n=30).Anesthesia induction:the plasma concentration of propofol in TCI was 1μg/ml.According to the bispectral index(BIS)value or the consciousness of patients,0.5μg/ml propofol was added every 3 min until the BIS was lower than 60 or the loss of consciousness.Then,sufentanil 0.3μg/kg and rocuronium 0.6 mg/kg were injected intravenously.Endotracheal intubation was performed after muscle relaxants were given for 3 min.Anesthesia maintenance:intraoperative BIS value was maintained between 40 and 60 and rocuronium and sufentanil were added according to muscle relaxation and circulatory index monitoring.The main observation indexes were the induction and maintenance dose of propofol;the secondary observation indexes were the dosage of sufentanil and rocuronium;the other observation indexes were the incidence of intraoperative cardiovascular ad-verse events and the time of extubation.Results A total of 57 patients completed the study,including 28 in the G group and 29 in the GE group.Compared with G group,the induction dose of propofol(1.4±0.3 vs 2.1±0.4 mg/kg)and maintenance dose of propofol(4.1±1.2 VS 7.9±1.4 mg/kg/h)of GE group were lower than those of G group.The extubation time was shorter than that of G group(4.6±2.8 vs 9.5±3.5 min),the dosages of sufentanil(18.2±3.1 vs 31.7±5.8μg)and rocuronium bromide(54.5±11.6 VS 68.3±14.9 mg)were less than those of the G group,the differences were statistically significant(P<0.05).The incidence of adverse cardiovascular events in the GE group was lower than that in the G group.Conclusion Lumbar epidural block can reduce the

关 键 词：脑电双频指数 硬膜外阻滞 全凭静脉麻醉 丙泊酚 老年. 

分 类 号：R614[医药卫生—麻醉学]