罗哌卡因硬膜外阻滞复合异丙酚诱导全麻的脑电双频谱观察

Ropivacaine epidural anesthesia combined with propofol - induced anesthesia of the entire observation bispectral

目的探讨罗哌卡因硬膜外阻滞对脑电双频谱（BIS）监测下异丙酚镇静以及麻醉诱导和维持需求量的影响。方法32例ASAI-Ⅱ级全麻复合硬膜外麻醉行上腹部手术患者，随机分为A组（对照组）和B组（罗哌卡因组），每组16例。T9Ⅷ硬膜外穿刺置管成功后连接BIS，硬膜外给药A组用0.9％的生理盐水，B组用0.15％的罗哌卡因，首次剂量10ml，然后以5ml／h持续硬膜外注射。以异丙酚3mg／s开始诱导，记录患者镇静状态、麻醉诱导和维持的异丙酚用量。结果达到镇静状态所需异丙酚剂量B组为（0.65±0.08）mg／kg，A组为（0.89±0.09）mg／kg，组间差异显著（P〈0.05）。B组异丙酚麻醉诱导剂量为（1.7±0.3）mg／kg，A组为（2.5±0.6）mg／kg，组间差异显著（P〈0.05）。术中维持BIS值在40-50所需异丙酚的剂量B组为（2.3±0.8）mg／（kg·h），显著低于A组的（4.0±1.4）mg／（kg·h）（P〈0.05）。结论全麻诱导前硬膜外罗哌卡因阻滞显著降低异丙酚镇静与麻醉诱导和维持的需求量。

Objective To research the effect of epidural ropivacaine on sedation,induction and maintenance dose of propofol. Methods 36 patients （ASA I-Ⅱ） undergoing epigast surgery under total anesthesia combined epidural block were randomly assigned to group A （control） and group B （ropivacaine）. After an epidural catheter was placed between T9-10 BIS monitor was connected. Group A received 0.9% NS and group B received 0.15% ropivacaine. 10ml of drug was admin- istered as a bolus via the epidural route 20 minutes before induction of anesthesia and then infusion was maintained at 5ml/h. Requirement of propofol for sedation,induction and maintenance were reeored. Results Sedation dose of propofol in group B （0.65±0.08） mg/kg was significantly lower than in group A （0.89±0.09）mg/kg （P〈0.05）. Requirement of propofol for induction in group B was （1.7±0.3） mg/kg compared with （2.5±0.6） mg/kg in group A （P〈0.05）. Propofol requirement for maintenance of anesthesia in group B was （2.3±0.8） mg/（ kg·h） compared with （4.0±1.4）mg/（kg·h） observed in group A （P〈0.05）. Conclusion Epidural ropivaeine significantly depress sedation, induction and maintenance dose of propofol.