靶控输注异丙酚复合硬膜外阻滞用于胃癌根治术  

Target Controlled Infusion Propofol Combined with Epidural Anesthesia during Radical Gastrectomy in Patients with Gastric Cancer

作　　者：方舒东[1] 林财珠[1] 张良成[1] 李晓峰[1] 杨锡馨[1] 

机构地区：[1]福建医科大学附属第一医院麻醉科,福州350005

出　　处：《福建医科大学学报》2003年第1期82-85,共4页Journal of Fujian Medical University

摘　　要：目的　评价靶控输注异丙酚复合硬膜外阻滞在胃癌根治术中对循环、脑电参数及应激反应的影响。　方法　 30例胃癌手术患者 ,随机分成靶控输注异丙酚全麻 (T)组 15例和靶控异丙酚复合硬膜外阻滞 T+E组 15例。持续监测围术期 BP、HR和脑电参数的变化 ,记录术前至术毕不同时点的血糖 (Glu)、皮质醇 (Cor)、胰岛素(Ins)的变化 ,术中药物用量和术后情况。　结果　 T+E组术后躁动 ,芬太尼、丙泊酚的用量低于 T组 (P<0 .0 5 ) ,两组苏醒时间相似。诱导后两组平均压 (MAP)显著下降 (P<0 .0 5 ) ,T组在探查、术毕、拔管后的 MAP比 T+E组显著增高 (P<0 .0 5 )。　结论　靶控输注异丙酚复合硬膜外阻滞用于上腹部手术具有异丙酚、芬太尼用量少、苏醒快、术后躁动少等优点 ,能较好地抑制应激反应 ,麻醉深度易于调控 。Objective\ To evaluate the effect of target controlled infusion(TCI) propofol combined with epidural anesthesia on the circulatory function, electroencephalograph, stress response during radical gastrectomy in patients with gastric cancer.\ Methods\ 30 patients with gastric cancer, were divided randomly into TCI propofol/fentanyl group(group T) and TCI propofol combined with epidural anesthesia(group T+E).\ In group T+E epidural was performed at T\-\{8~9\} and epidural catheter was placed and 0 5% ropivacaine was given before induction of general anesthesia.\ Hemodynamics and electroencephagram were monitored and intraoperative awareness, postoperative, restlessness, anesthetic dosage and time for emergence and orientation were recorded, also the concentrations of blood glucose, serum insulin, cortisol were determined at pre\|operation, induction, skin incision, exploration and end of the surgery.\ Results\ Total dose of propofol was statistically lower in group T+E than that group T(P<0 05), same was the standardized unit dose of propofol, postoperative restlessness in group T+E significantly lower than in group T.\ BIS and SEF levels in both groups from induction to surgery over were significantly lower than those in pre\|induction, but there were unsignificantly between groups during whole procedures.\ The awakening time in two groups were similar, MAP in both groups after induction were significantly lower than in pre\|induction.\ The hemodynamics in group T+E was more stable than that in group T at exploration after surgery and extubation.\ The increase in cortisol was significantly greater in group T than in group T+E after surgery.\ There was no significant change in insulin.\ \{Conclusion\}\ Target controlled infusion propofol combined with epidural anesthesia during radical gastrectomy in patients with gastric cancer has the advantages of less propofol, rapid emergence, less postopertive restlessness, less stress response, more stable blood pressure and more accurate adjustment of depth of \{anesthesi

关 键 词：二异丙酚 麻醉 硬膜外 脑电描记术 输注 静脉内麻醉 

分 类 号：R614[医药卫生—麻醉学]