硬膜外麻醉复合吸入全麻对异氟醚最低肺泡清醒浓度的影响

Influence of epidural anesthesia combined inhalation anesthesia on MAC-awake of isoflurane

目的观察硬膜外麻醉复合吸入全麻对异氟醚最低肺泡清醒浓度(MAC-awake)的影响。方法200例腹部外科择期手术病人,随机分为两组:I组(单纯吸入全麻组,100例)和EI组(硬膜外麻醉复合吸入全麻组,100例)。EI组先给予硬膜外麻醉。两组均选择异丙酚和维库溴铵诱导进行气管内插管,术中均用异氟醚、维库溴铵维持麻醉;均用Evans麻醉深度评分法维持术中麻醉深度在2￣4分之间。记录异氟醚MAC-awake值;苏醒时间;潮气量(TV)、呼吸频率(RR)、血压(BP)、心率(HR)、动脉血二氧化碳分压(PCO2)、动脉血氧分压(PO2)、肌松及有无躁动情况。结果EI组异氟醚MAC-awake值明显低于I组,苏醒时间却更长(P<0.05);TV、RR、PCO2、肌松(TOF值:T4/T1>75%)差异无显著性意义(P!0.05);BP、HR较I组平稳(P<0.05);躁动例数(2例)明显少于I组(29例)。结论硬膜外麻醉复合吸入麻醉能降低异氟醚最低肺泡清醒浓度;维持循环系统稳定;减少术后躁动。

[Objective] To observe the influence to the MAC-awake of the isoflurane by the epidural anesthesia combined inhalation anesthesia. [Methods] 200 patients for abdominal operation were divided into two groups randomly： group Ⅰ （only inhalation anesthesia n=100）; group El （epid-ural anesthesia combined inhalation anesthesia n= 100）. There was epidural anesthesia to the patients in group El at first. Chose propofol, vecuronium for anesthesia induction and isoflurane, vecuronium for anesthesia maintenance in two groups. Controled anesthesia depths 2-4 points in the method of Evans about anesthesia depths in two groups. Signed the MAC-awake of isoflurane, the time of patients, awake-period, tidal vidume （TV）, respiratory rate（RR）, BP, HR, PO2, PCO2, the function of muscular contraction and restlessness. [Results] The MAC-awake of isoflurane in groupEl was less than that in group Ⅰ, but the awake-period was longer （P 〈0.05）. There were no differences of TV, RR, PCO2 in each group （P 〉0.05）. There were significant differences of BP, PR, PO2 and the restlessness between the two groups （P 〈0.05）. Muscular tension was normal at two points of the time in two groups. [Conclusions] The MAC-awake of isoflurane can be reduced by the epidural anesthesia combined inhalation anesthesia. The anesthesia can control circulatory system and reduce the patients, restlessness.