硬膜外罗哌卡因对全凭静脉麻醉异丙酚用量的影响

The Effect of Epidural Anesthesia with Ropivacaine Combined with Total Intravenous Anesthesia on the Requirement of Propofol

目的 :探讨新型局麻药罗哌卡因复合全凭静脉麻醉对靶控输注异丙酚用量的影响。方法 :选择ASAI～II级胸腹部手术病人 4 0例 ,30岁以上成人 ,体重超过 4 5kg ,无心、肺、肝、肾及代谢性和神经系统疾病。随机分成两组 ,硬外罗哌卡因复合全凭静脉麻醉组 (罗哌卡因组 ) ,和单纯全凭静脉麻醉组 (单纯全麻组 ) ,每组 2 0例。所有病人在全麻诱导前于T7～T10 硬膜外间隙穿刺置管 ,罗哌卡因组经导管注入 0 .75 %罗哌卡因 5ml,单纯全麻组注入生理盐水 5ml。 5min后全麻诱导 ,顺序静脉注射芬太尼 3μg/kg,异丙酚血浆目标浓度 4 μg/ml。病人意识消失后 ,静注维库溴铵 0 .1mg/kg,然后把异丙酚血浆目标浓度降为3.3μg/ml维持麻醉。 2min后气管插管。机械通气 ,潮气量 10ml/kg。术中每 4 5min追加芬太尼 2 μg/kg ,罗哌卡因组每 90min追加 0 .75 %罗哌卡因 3ml,适时追加维库溴铵 0 .0 5mg/kg,满足肌松需要。术中增加或减小异丙酚血浆目标浓度 ,每次 0 .1μg/ml,使BIS值维持在 5 0± 5范围内。记录入室后 (基础值 )和术中血液动力学、BIS和HRV。结果 :单纯全麻组中有 1例行肺癌根治术 ,术中广泛渗血 ,从组中剔除。两组间性别、年龄、体重、手术种类无显著差异 (P >0 .0 5 )。罗哌卡因组的芬太尼用量 <单纯全麻组(P <0 .

Objective: To investigate the effect of epidural anesthesia with ropivacaine combined with total intravenous anesthesia on the reqirement of propofol when target-controlled infusion technique was used. Methods: Forty ASAI～II patients scheduled to undergo elective thoracic and abdominal surgery were assigned to receive either epidural anesthesia with ropivacaine combined with total intravenous anesthesia lgroup R, n=20) or completely total intravenous anesthesia lgroup G, n=20). An epidural catheter was inserted at the T 7～T 10 interspace in all patients before induction and then 0.75% ropivacaine 5ml in group R and saline 5ml in group G was administered respectively. Fentanyl 3μg/kg, propofol TCI 4μg/ml, and vacurium 0.1mg/kg were consecutively used for induction. The target plasma concentration of propofol was decreased to 3.3μg/ml after the patients lost consciousness. Tracheal intubation was performed 2min later. The lungs were ventilated with 100% oxygen and tidal volume was 10ml/kg. Fentanyl 2μg/kg, was administered every 45min during operation and 0.75%ropivacaine 3ml was injected by epidural catheter every 90min in group R. The plasma target concentration of propofol was up-down regulated by 0.1μg/ml to maintain the BIS around 50±5.The changes of hemodynamic, bispectral index and heart rate variation of perioperation were recorded. Results: No statistical differences were found on the demographic data and operative details between two groups except for one patient was excluded due to hemorrhage in group G. The requirement of fentanyl in group R was smaller than group G(P<0.05). The approximate requirement of propofol was found (P>05) and the time from the end of anesthetic agents to eye opening was similar as well between two groups(P>0.05). There were significant decreases in SBP, LF/HF, LF, HFand TP in group R( P<0.05). No significant differences on DBP, HR, and BIS were found between two groups(P>0.05). Conclusion:Epidural anesthesia with small doses of 0.75% ropivacaine combined with total intravenous anesthesia by target-controlled infusion of propofol can reduce the requirement of fentanyl and effectively balance the autonomic system, though the requirement of propofol can not be reduced.