持续靶控输注异丙酚复合硬膜外麻醉用于上腹部手术探讨

DISCUSSION OF APPLYING CONTINUOUS TCI OF ISOPROPYL HYDROXYBENZENE IN COMPOUND EPIDURAL ANESTHESIA TO EPIGASTRIC OPERATION

目的:评价持续靶控输注异丙酚复合硬膜外阻滞有用于上腹部手术的可行性。方法:30例胃癌手术患者,ASAⅠ～Ⅱ级。随机分成靶控输注异丙酚全麻(T)组15例,靶控异丙酚复合硬膜外阻滞(T+E)组15例。结果:(T+E)组术后躁动、芬太尼、丙泊酚的用量低于(T)组(P<0.05)。异丙酚单位标准化剂量亦较低。两组苏醒时间相似。诱导后两组血压均显著下降(P<0.05),T+E组在诱导后DBP的下降幅度较T组更为显著(P<0.05),T组在探查、术毕、拨管后的SBP、DBP、MAP比(T+E)组显著增高(P<0.05)。两组诱导后至术毕BIS、SEF显著下降,两组间的比较无统计学意义(P>0.05)。结论:靶控输注异丙酚复合硬膜外阻滞用于上腹部手术是可行的,具有异丙酚、芬太尼的用量少、苏醒快、术后躁动少,麻醉深度易于调控,血液动力学较稳定,是一种良好的麻醉方式。

Objective:To estimate the feasibility of continuous target controlled infusion of isopropyl hydroxy-benzene in compound epidural block of epigastrium operation. Method:30 cases of patients with gastric carcinoma, ASA grade Ⅰ- Ⅱ ,15 cases with TCI of isopropyl hydroxybenzene in general anesthesia as group T, 15 cases with TCI of isopropyl hydroxybenzene in compound epidural block as group T+ E.Results:Group T+ E were restless after operation.The dosage of fentanyl and isopropyl hydroxybenzene was less than that in Group T (P<0.05).The unit standard dosage of isopropyl hydroxybenzene was also less. The awaking time in both groups was almost the same. Blood pressure of the two groups was lowered significantly after induction(P<0.05). The lowered range of DBP in Group T + E was more significant than in Group T(P<0.05). In detecting,after operation,after pulling out the tube,SBP,DBF,MAP increased more significantly in Group T than in Group T+ E. BIS.SEF in both group were significantly lowered in the period of induction to post - operation. Comparison between the two groups was of no statistical significance (P>0.05).Conclusion:TCI of isopropyl hydroxybenzene in compound epidural block can be used in the epigastric operation. It has the advantages as less dosage of isopropyl hydroxybenzene and fentanyl, shorter awaking time,less restlessness,easier to control the degree of anesthesia,more stable of the patients' hemo-dynamics.so it is a better anesthetic way.