异丙酚用于硬膜外-全麻联合麻醉的临床观察

Evaluation of Epidural Block Combined with General Anesthesia with Propofol or Isoflurane

目的:探讨异丙酚用于硬膜外-全麻联合麻醉的效果。方法:40例择期行胆囊切除术的患者随机分为两组:观察组和对照组,每组各20例。观察组使用异丙酚硬膜外-全麻联合麻醉,对照组使用异氟醚硬膜外-全麻联合麻醉。比较两组术中血压(MAP)、心率(HR)变化以及术后拔管时间、苏醒评分差异。结果:两组在诱导插管后均出现一度的MAP及HR显著性下降(P<0.01),术中进腹探查时两组病人均出现一定程度的MAP回升,使用异丙酚者回升幅度稍大(P>0.05),以后两组病人术中MAP及HR均较平稳。观察组异丙酚术中注速平均为(4.7±1.3)mg/(kg.h)。观察组术中芬太尼的用量与对照组比较,有显著性差异(P<0.05)。拔管时间:观察组为(3.5±5.7)min,对照组(3.6±8.6)min,两组比较,无显著性差异(P>0.05)。苏醒评分:两组在术后10 min、30 min时组间比较无显著性差异(P>0.05),观察组在术后60 min以后苏醒评分明显高于对照组(P<0.01)。结论:异丙酚用于硬膜外-全麻联合麻醉时,可使用较小剂量的异丙酚维持麻醉,诱导后和进腹探查时血压波动较大,且术中芬太尼用量较大,与使用异氟醚硬膜外-全麻联合麻醉的拔管时间及苏醒质量相似,不具有显著优势。

Objective.To evaluate the effects of epidural combined with propofol general anesthesia during cholecystectomy. Methods：Forty patients with ASA class Ⅰ-Ⅱ who underwent cholecystectomy were randomly assigned to be operated on under epidural block combined with propofol general anesthesia（group Ⅰ,n=20）or under epidural block combined with isoflurane general anesthesia（group Ⅱ , n = 20）. Results ： MAP and HR decreased significantly （P〈 0.01 ） after induction. There was a gentle increase of MAP during exploratory operation. These changes were more evidently in group Ⅰ. Later perioperation, MAP and HR didn＇t change obviously. The infusion rate of prpofol was （4.7 ± 1.3）mg/（kg · h） in group Ⅰ. During operation the dose of fentanyl was more（P〈0.01）in group Ⅰ than group Ⅱ. The difference wasn＇t obvious about the time of extubation in both groups, （3.5±5.7）min in group Ⅰ , （3.6±8.6）rain in group Ⅱ. There was no significant difference of OAA/S postoperation at 10 min and 30 min, but it increased significantly（P 〈0.01）at 60 min and 120 min in group Ⅰ compared to that in group Ⅱ. Conclusion： For epidural block combined with general ar.esthesia following propofol during cholecystectomy, the dose of propofol to maintaim anesthesia is less,and the changes of MAP and HR are evident after induction and during exploratory operation. However the time of extubation and the quality of awareness following isoflurane is similar.