异丙酚不同给药方法辅助硬膜外阻滞时的血浆浓度与镇静作用

Plasma Concentrations and Sedative Effects of Propofol Given in Different Doses as an adjuvant for Epidural Block

目的：探讨异丙酚最适给药方法，在４２例硬膜外麻醉下行上腹部手术的患者研究了三种给药法的血浆浓度和临床效应。方法：组１异丙酚负荷量１．５ｍｇ／ｋｇ，３ｍｉｎ后开始维持量３．７５ｍｇ·ｋｇ－１·ｈ－１。组２负荷量０．７５ｍｇ／ｋｇ，随之接与组１相同维持量。组３以０．１５ｍｇ·ｋｇ－１·ｍｉｎ－１共６ｍｉｎ为负荷量，立即接维持量。手术进腹前，为消除患者意识，以免牵拉内脏不适，在给予０．１μｇ／ｋｇ芬太尼同时，于１ｍｉｎ内注入异丙酚１５ｍｇ并将维持量增加０．７５ｍｇ·ｋｇ－１·ｈ－１。结果：（１）组１给药后１ｍｉｎ血浆异丙酚浓度２．４２μｇ／ｍｌ，血压下降，呼吸暂停，舌下坠和ＳｐＯ２低于９０％的发生率高；而组２、组３负荷量后血浆浓度１．３８１～１．４７９μｇ／ｍｌ，不发生呼吸暂停和ＳｐＯ２严重降低。（２）三组维持量３．７５ｍｇ·ｋｇ－１·ｈ－１给药，血药浓度１．１０９～１．３０８μｇ／ｍｌ，Ｒａｍｓａｙ镇静计分３～４分，维持量４．５ｍｇ·ｋｇ－１·ｈ－１时，血浆浓度１．５１３～１．６０８μｇ／ｍｌ。Ｒａｍｓａｙ计分５分，给药量、血药浓度、镇静深度之间相关性好，调整容易。（３）术中无恶心、呕吐或鼓肠；停药后迅速清醒，?

Objective: Plasma concentrations and effects of propofol used as an adjuvant in different doses during epidural block were studied. Methods:42 patients undergoing upper abdominal surgery were allocated into three groups with 14 cases each. A bolus injection of propofol 15mg/kg was given and 375mg·kg-1·h-1 of it was infused continuously in group I. The patients in group Ⅱ was given a bolus propofol of 075mg/kg and a contious infusion of propofol was followed as in group I.In group Ⅲ,05mg·kg-1·h-1 of propofol was infused for 6min and 375mg·kg-1·h-1 pumped as in group I.To eliminate uncomfortable response to visceral traction, fentanyl 01μg/kg was administered and followed by propofol 45mg·kg-1·h-1 iv. Results:(1)The plasma concentrations of propofol was 2421μg/ml at 1min after bolus injection, which was accompanied by hypotension, aponea, back movement of the tongue and a high incidence of low SpO2(<90%) in group I.The concentration of propofol was 1381～1479μg/ml after bolus injection without aponnea and severe reduction of SpO2 in both group Ⅱ and Ⅲ.(2)During continuous infusion, plasma concentration of propofol was 1109～1308μg/ml with Ramsay score of 3～4 points when infusion rate was 375mg·kg-1·h-1 and it was 1513～1618μg/ml with Ramasy score of 5 points when infusion rate 45mg·kg-1·h-1. There was a good correlation among dose, plasma drug concentration and sedation.(3) No nausea, vomiting and intestinal distention occurred in all groups. The patients awaked soon after discontinuation of propofol infusion. Conclusion: Propofol is a suitable adjuvant for epidural block when used properly.