不同镇静方法在硬膜外麻醉中的效果及安全性研究

Safety and effect of different conscious-sedation methods during epidural anesthesia

目的采用不同的镇静方法对硬膜外麻醉中的镇静效果进行观察,旨在寻求安全有效的硬膜外镇静方法.方法对116例ASAⅠ～Ⅱ级乳腺病患者,随机分为A、B、C 3组,3组均接受高位硬膜外麻醉,并分别接受不同的镇静方法.分别于入室时、意识清醒时、切皮时及清除腋窝淋巴结时测定SBP、DBP、HRP、PETCO2、RR及皮质醇浓度,持续观察脑电双频谱指数(BIS)值,并采用OAA/S评分.结果A组BIS值处于睡眠范围,不能消除牵拉刺激及术后回忆,B组不能完全消除术中应激反应,但术前回忆极少,C组BIS值处于麻醉范围,皮质醇浓度较术前明显下降,同时伴有心率减慢及SBP、DBP下降,呼气末CO2浓度升高.结论B组作为硬膜外镇静方法,临床效果稍差,但仍可使用;A、C组均可作为临床常用的镇静方法使用,但C组要求设备条件较高,且有明显的循环、呼吸功能抑制,特别在老年患者要慎用.

Objective To explore a safe and effective conscious-sedation method by research on the sedation effect of different conscious-sedation methods during epidural anesthesia. Methods One hundred and sixteen patients with breast cancer of ASA grade Ⅰ and Ⅱ underwent epidural anesthesia and different sedation methods were randomly divided into 3 groups：group A,B and C. The SBP, DBP, HR, PETCO2, RR and concentration of hydrocortisone were recorded. BIS value were observed continuously and the OAA/ S score were obtained respectively at the time of entering operating-rcom, conscious loss,operation initiation and axillary lymph node clearing. Results In group A, the BIS value was in sleep condition, and drag stimulation and palinmnesis after operation couldn＇t be avoided. In group B, stress during operation couldn＇t be precluded completely but palinmnesis after operation was seldom. The BIS value of group C was in drugged state and the concentration of hydrocortisone was decreased obviously. The level of SBP, DBP and HR were decreased, but PETCO2 was increased at the same time. Conclusion The effect of group B is not satisfied. Groups A and C show better effects and can be used in clinical practice. But there are some shortcomings in group C： the equipment is complicated, and obvious respiratory and circulatory inhibition may occur. It should be used carefully in old patients.