得普利麻两种给药方法用于硬膜外麻醉时镇静的对比研究

Different doses of propofol infusion for sedation during epidural anesthesia

目的 :研究得普利麻在硬膜外麻醉时两种给药方法的血药浓度变化和临床效应。 方法 :将 2 8例连续硬膜外麻醉下行上腹部手术患者分为两组。第 1组采用常规给药法 :诱导量 1.5mg/ ( kg.min) ,3min后开始维持量 3mg/ ( kg.h) ;第 2组以 0 .15mg/ ( kg.min)速度共 6min诱导 ,随即用与第 1组相同维持量。两组诱导时均辅以芬太尼 0 .1μg/ kg。测定给药前及给药后 1、3、6、10、2 0、30 min血药浓度。 结果 :1第 1组给药后 1min血药浓度 2 .4 2 1μg/ ml,血压下降较显著 ,呼吸暂停 ( 36% )、舌后坠 ( 36% )和动脉氧饱和度 ( Sp O2 )低于 90 % ( 2 8.6% )发生率高。2第 2组诱导后血药浓度 1.4 99μg/ ml,未发生呼吸暂停 ,舌后坠轻微 ,Sp O2 均高于 95%。 3两组术中镇静满意 ,调节镇静深度容易 ,术后无恶心、呕吐。 结论 :采用第 2组给药方法可始终维持最低有效镇静浓度 ,此法安全、理想 。

Objectives:To compare the clinical effects and plasma concentrations of dif- ferent doses of propofol infusion during epidural block. Methods:Twenty- eight patients (ASA 1 to 2 ) scheduled to undergo upper abdominal surgery under epidural anesthesia were divided into2 groups.Patients in group1 received an initial dose of1 .5 mg/kg propofol ove1min,3min later a continuous infusion of3mg/(kg·h) was given.Patients in group2 re- ceived0 .1 5 mg/(kg·min) propofol over6 min,followed by an infusion ata rate of3.0 mg/ (kg· h) .At the beginning of infusion,0 .1μg/kg fentanil was administered.Plasma concen- trations of propofol before and at1 ,3,6 ,1 0 ,2 0 ,30 min after the administration of propofol were measured.Depth of sedation levels (Ramsay Score) and side effects were monitored. Results:In group1 ,36 % patients had severe upper airway obstruction and apnea,2 8.6 % pa- tients showed a transient fall in Sp O2 under90 % ,these adverse effects occured atthe time of peak effect of the bolus injection.In group 2 satisfactory sedation was obtained at steady blood level0 .93～ 1 .49μ g/ml,no severe airway obstruction and apnea occured.Using an in- fusion system,the depth of sedation could be controlled and modulated easily.Five min after stopping the infusion,all patients were awake and well orientated.No nausea and vomiting occurred. Conclusions:Propofol is a suitable sedative agent for epidural anesthesia when used at suitable doses to establish a constant target concentration.