皮肤电传导率用于硬膜外麻醉丙泊酚镇静的监测

Skin conductance during epidural anesthesia monitoring of propofol sedation

目的探讨在硬膜外麻醉下靶控输注（target-controlled infusion,TCI）异丙酚镇静下,皮肤电传导率（skin conductance,SC）在监测意识状态的应用。方法择期硬膜外麻醉骨科手术患者30例,年龄22~47岁,体重51~83 kg,美国麻醉医师协会（The American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级,无术前用药,无心、肺疾病,无气道通气障碍;硬膜外麻醉起效后,用异丙酚输注泵靶控异丙酚,以0.6μg/ml为初始浓度,以0.6μg/ml递增,直至改良镇静警醒（OAA/S）评分≤2级,停止靶控输注,患者逐步恢复意识,直至OAA/S评分恢复至5级,每3分钟评价OAA/S评分,同时记录SC、MAP和HR。结果 SC能较好地反映病人镇静时的意识状态（P〈0.01）;OAA/S评分与SC有显著相关性,r为-0.859（P〈0.01）,明显好于MAP和HR。结论 SC能正确反映靶控输注异丙酚镇静时的镇静深度。

Objective To investigate epidural anesthesia under propofol sedation,skin conductance（skin conductance,SC） in monitoring the application of consciousness.Methods Thirty American society of anesthesiologists（ASA） Ⅰ～Ⅱ patients,aged 22～47 years,weighing 51～83 kg,epidural anesthesia for orthopedics surgery were enrolled into this study.None of the participants received premedication on the day of surgery.After the onset of epidural anesthesia,TCI of propofol was initiated at target plasma concentration of 0.6 μg/ml,increased by 0.6 μg/ml until OAA/S≤2 stop the target controlled infusion,the patients were gradually regained consciousness,until the OAA/S score returned to 5,every 3 minutes evaluated the OAA/S score,SC,MAP and heart rate（HR） values were recorded.Results SC through research that can better reflect the patients′ state of consciousness during sedation（P0.01）,significantly better than MAP and HR;The OAA/S score had negtive correlation with SC（r=-0.859,P0.01）.In the OAA/S score comparisons for each level,SC was better than MAP,HR.Conclusion SC can accurately reflect the target-controlled infusion of propofol sedation.