硬膜外阻滞对异丙酚镇静作用的影响  

Potential Effects of Epidural Blockade on Propofol′s Sedative properties

作　　者：须挺[1] 杨建平[1] 张凡[1] 

机构地区：[1]苏州大学附属第一医院麻醉科,苏州215006

出　　处：《苏州大学学报（医学版）》2003年第5期557-558,619,共3页Suzhou University Journal of Medical Science

基　　金：江苏省教育厅基金资助项目(KJS0 2 0 5 6);江苏省卫生厅基金资助项目(WK2 0 0 2 0 1);苏州大学医学发展基金资助项目(EE12 2 0 3 1)

摘　　要：目的　应用临床和脑电双频谱指数监测 ,评价硬膜外阻滞后患者达到意识丧失时所需异丙酚的剂量 ,并探讨其可能的机制。方法　将 30例ASAⅠ～Ⅱ级下肢、下腹部手术患者 (术前用药一致 )随机双盲法分为硬膜外阻滞组 (E组 ,n =15 )和对照组 (C组 ,n =15 )。E组在硬膜外腔注入 0 .75 %布比卡因 15ml;C组行硬膜外穿刺后 ,在硬膜外置管备用不注药。两组均在穿刺完毕后 2 0min开始连续静脉泵入异丙酚至意识丧失 ,并记录异丙酚用量。所有患者均监测脑电双频谱指数。结果　两组意识丧失时异丙酚用量E组明显少于C组 (P <0 .0 5 ) ,监测所得的基础BIS值、泵入异丙酚前BIS值、意识丧失时BIS值两组间无差异。在同一组中 ,基础BIS值和泵入异丙酚前BIS值无差异 ,而意识丧失时BIS值均低于基础BIS值和泵入异丙酚前BIS值。结论　硬膜外阻滞降低患者意识丧失时所需异丙酚的用量。其主要机制可能是硬膜外阻滞阻断了局部的传入信号 ,降低了对网状激活系统的刺激 。Objective To investigate the potential effects of epidural blockade on propofol′s sedative pro perties. Methods Thirty ASAⅠ-Ⅱ patients aged 20～55 undergoing lower abdomen or lower limbs operation were studied. Alcoholics and those addicted to sedative or opiates were excluded. The same premedication was given. The patients were randomly divided into two groups: epidural group (group E, n=15);control group (group C, n=15). In group E,the patients received epidural 15 ml of 0.75% bupivacaine.In group C,the patients received epidural puncture, a catheter was kept in epidural space, no medicine was given in group C. Twenty minutes after all needle insertions, a propofol infusion was started at a rate of 20mg/kg·h -1 until the patients lost consciousness. The amount of propofol infused was recorded. The bispectral index was continuously monitored. Results The amount of propofol infused when the patients lost consciousness was 1.75 mg/kg in group E and 2.11 mg/kg in group C. The amount of propofol infused in group E was significantly less than that in group C ( P< 0.05). There was no significant difference in the basic BIS score, the BIS score before propofol infused and the BIS score when the patients lost consciousness between two groups. In the same group, there is no significant difference between the basic BIS score and the BIS score before propofol was infused, but the BIS score when the patients lost consciousness was significantly less than the basic BIS score and the BIS score before propofol was infused ( P <0.05). Conclusion Epidural blockade significantly reduces propofol requirement. We hypothesize that the reduction in hypnotic requiems is due to the decreased input induced by the epidural blockade,this may be the important mechanism.

关 键 词：双频谱指数 硬膜外阻滞 异丙酚 镇静 

分 类 号：R614.42[医药卫生—麻醉学]