硬膜外注入不同浓度罗哌卡因对全麻患者异丙酚及异氟醚用量的影响.docVIP

　　硬膜外注入不同浓度罗哌卡因对全麻患者异丙酚及异氟醚用量的影响 　　【摘要】目的 观察在相同麻醉深度下,硬膜外注入不同浓度罗哌卡因对全麻患者异丙酚及异氟醚用量的影响。方法 45例择期上腹部手术患者,根据复合硬膜外用药的不同随机分为三组:生理盐水对照组(Ⅰ组)、0.5%罗哌卡因组(Ⅱ组)、0.75%罗哌卡因组(Ⅲ组),每组15例。硬膜外阻滞平面确定后麻醉诱导以25mg/min异丙酚连续输注至患者神志消失;麻醉维持吸入异氟醚使脑电双频谱指数值(BIS)维持在50～55,硬膜外以7mL/h泵注维持。记录异丙酚用量、异氟醚呼气末浓度(ETiso)及BIS、听觉诱发电位指数(AAI)。结果 患者意识消失时异丙酚的用量:Ⅰ组(1.7±0.4)mg/g、Ⅱ组(1.2±0.3)mg/kg和Ⅲ组(1.0±0.3)mg/kg,Ⅲ组和Ⅱ组异丙酚用量比Ⅰ组明显减少(Plt;0.01)。ETiso分别为Ⅰ组(0.85±0.10)%,Ⅱ组(0.65±0.06)%,Ⅲ组(0.57±0.12)%,Ⅱ组、Ⅲ组比Ⅰ组和Ⅲ组比Ⅱ组明显降低(Plt;0.01或0.05)。结论 维持相同的麻醉深度下,硬膜外注入0.5%罗哌卡因组比0.75%罗哌卡因组既能减少全麻药的用量,又能保持循环的相对稳定。 　　【关键词】麻醉,硬膜外;异丙酚;异氟醚;罗哌卡因;全身麻醉 　　 　　【Abstract】Objective To evaluate the effects of epidural infusion of different concentration of ropivacaine on the amount of propofol needed to induce anesthesia and the egd-tidal isoflurane concerttration neededto maintain BIS at 50-55 during operation.Methods Forty-five ASAⅠ-Ⅱpatients of both sexes aged 21～60 years,inal surgery ly divided into 3 groups(n=15 each):group I epidufal normal saline(NS);group Ⅱ epidural 1%ropivacaine (Lido) and groupⅢ2%Lido.An epidural catheter cephalad.After a test dose of 3ml,NS or 　　1%or 2%Lido 10 ml g/min.Propofol infusion esponding to lohld voice(OAAS/2) and the amount of propofol infused 0.15 mg/kg echanically ventilated and PETCO2aintained at 35mmHg. AnestheSia aintained l/h.BIS aintained 　　at 50～55 dμring operation.Results The amount of propofol needed to induce anesthesia g/kg in group Ⅱ and(1.02±0.25)mg/kg in group Ⅲ pared to(1.67±0.38)mg#8226;kg-1 in control group(group I)(Plt;0.01).The end-tidal isoflurane concentration ount of general anesthetics needed to induce and maintain general anesthesia during bined general-epidural anesthesia in a dose-dependent manner. 　　【Key . 　　1.2 麻醉方法 麻醉前30 min肌内注射苯巴比妥钠0.1g、阿托品0.5mg。常规左侧卧位,T9～10。硬膜外穿刺头向置管3～4cm,平卧后硬膜外分别注入试药液(1组0.9%生理盐水;Ⅱ组、Ⅲ组罗哌卡因由ASTRA公司生产,批号BC495)3 mL,5min后无误入血管或全麻症状后,再注入7 mL。10min测定痛觉平面后经肘正中静脉用Graseby3500泵以25mg/min输注异丙酚,当患者意识消失、对大声呼唤无反应时,停止输注异丙酚,静脉注射芬太尼2μg/kg和维库溴铵0.15mg/kg麻醉诱导,行气管插管。而后硬膜外以7mL/h泵注维持。机械通气