异丙酚辅助下腹部手术硬膜外麻醉的临床观察.doc

???? 异丙酚辅助下腹部手术硬膜外麻醉的临床观察 ???? ????摘要　目的：比较硬膜外辅助用药的作用。方法：30例病人随机分为三组，每组10例。麻醉完善后，组Ⅰ，先静注异丙酚0.8mg／kg，继之用微泵持续输注2mg.kg－1.h－1；组Ⅱ，静注安定 5mg，继之微泵持续输注异丙酚2mg.kg－1.h－1。组Ⅲ，给予哌替啶50mg、氟哌啶2.5mg静注。结果：异丙酚组在用药后5min呼吸抑制明显，10min后渐正常；组Ⅲ在10至30min之间表现较强的呼吸抑制。组Ⅰ在用药后5至10min血压降低明显。组Ⅰ、Ⅱ病人VAS优良率达90％，组Ⅲ仅为40％。结论：以安定5mg加异丙酚2mg.kg－1.h－1辅助硬膜外麻醉具有诱导与维持平稳舒适、对循环呼吸功能影响轻微、术后恢复好、抗呕吐作用强等优点。　　关键词　　异丙酚　硬膜外阻滞　氟哌啶　安定　哌替啶 Clinical Observation of Propofol Used as an Adjuvant during Epidural Blockade in Lower Abdominal OperationsMa Jun, Wang Jun, Wang Huizhen, et alDepartment of Anesthesiology, Second Peoples Hospital of Qingdao 　　Objective:To compare the effect of adjuvants for epidural blockade.Methods: 30 surgical patients were allocated randomly into three groups with 10 each. After epidural blockade was established, propofol　0.8mg／kg was injected in bolus and infused continuously at a rate of 2mg.kg－1.h－1 in groupⅠ. In group Ⅱ, diazepam 5mg was used and propofol infused as in group Ⅰ. In groupⅢ,pethidine 50mg and droperidol 2.5mg were injected as a control. Results: A significant respiratory depression was seen at 5 and 10 min after propofol in group Ⅰ and Ⅱ. The respiratory depression was still signifieant at 30min after injection of pethidine and droperidol in group Ⅲ. There was a significant decrease in BP at 5 and 10 min after propofol in group Ⅰ. The VAS＞7～8 reahed 90％ in group Ⅰ and Ⅱ, but only 40％ in group Ⅲ. Conclusion:As the adjuvants of epidural blockade propofol infusion at a rate of 2mg.kg－1.h－1 following diazepam 5mg has some advantages of sooth induction and maintenance, less circulatory and respiratory depression, better postoperative recovery and stronger antiemetic effect.　　Key words　　Propofol　Epidural blockade　Droperidol　Diazepam　Pethidine 　　对异丙酚在硬膜外麻醉期间的应用效果，我们作了初步临床观察，现报告如下。 1　资料与方法　　30例ASAⅠ～Ⅱ级病人随机分为三组，每组10例，年龄、体重相当（P＞0.05）。手术种类包括子宫切除、卵巢肿瘤切除、阑尾切除和肠部分切除等下腹部手术。三组病人在硬膜外阻滞完善后（T6～S3）。Ⅰ组（异丙酚组）：异丙酚0.8mg／kg静注，继之用微量泵持续输注2mg.kg－1.h－1。Ⅱ组（安异组）：先安定5mg静注，继之用微量泵持续输异丙酚2mg.kg－1.h－1。Ⅲ组（氟哌组）：为对照组，一