不同硬膜外阻滞平面对手术患者丙泊酚镇静的影响

Effect of Different Levels of Epidural Block on Sedation of Propofol in Patients Subject to Surgical Operation

目的研究不同硬膜外阻滞平面对手术患者靶控输注丙泊酚镇静和用量的影响。方法选择择期中下腹部手术行硬膜外阻滞麻醉的患者60例,ASAⅠ-Ⅱ级,分为中阻滞平面组（T4组,n=32）和低阻滞平面组（T10组,n=28）。两组麻醉阻滞平面分别控制在T4和T10以下,观察15 min后,分别在脑电双频指数（BIS）指导下靶控输注丙泊酚,输注30 min后停止。记录硬膜外阻滞前,硬膜外阻滞后每5分钟及输注丙泊酚前、后各时间点的脑电双频指数（BIS）和警觉/镇静（OAA/S）评分,并记录达到镇静程度的诱导时间、恢复时间及丙泊酚的诱导用量和维持用量。结果中阻滞平面组（T4组）的患者镇静诱导时间较低阻滞平面组（T10组）缩短（P〈0.01）,从镇静状态恢复到清醒的恢复时间较低阻滞平面组（T10组）延长（P〈0.05）,中阻滞平面组丙泊酚诱导和维持用量较低阻滞平面组减少（P〈0.01）。结论与低位硬膜外阻滞比较,中位硬膜外阻滞时丙泊酚镇静起效较快,恢复较慢,并可减少丙泊酚用量。

Objective To study the effects of different levels of epidural block on requirement of propofol during BIS guidance.Methods Sixty ASAⅠ-Ⅱ patients undergoing middle and lower abdominal operation under epidural block,were divided into median level block group（group T4）,and low level block group（group T10）.Fifteen min after epidural block,propofol infusion was done under the direction of BIS for 30 min.Alartness score（OAA/S）,and bispectral index（BIS）were recorded before and every 15 min after epidural block,and at different time points after propofol infusion.The doses of propofol for induction,and maintenance,onset time,recovery time were recorded.Results Onset time in median level block group was faster than in low level block group,but recovery time was slower than that in low level block group.Total dose of propofol was less in median level block group than in low level block group.Conclusion Median level of epidural block was associated with a faster onset,delayed recovery time and lower doses of propofol during propofol anesthesia compared with low level of epidural block.