微泵持续输注硬膜外麻醉对肿瘤患者血流动力学及皮质醇含量的影响

Effect of micropump continuous infusion in epidural block on hemodynamics and cortisol in patients with neoplasm

目的 :观察微泵持续输注法硬膜外麻醉效果及对肿瘤患者血流动力学、皮质醇的影响。方法 :12 2例ASAⅠ～Ⅱ级拟行上、中腹部手术的肿瘤患者 ,随机分为Ⅰ组 (微泵持续注药组 ) 6 1例和Ⅱ组 (间断注药组 ) 6 1例。 2组患者均选用 10g/L利多卡因和 2 .5g/L丁卡因混合液。硬脊膜外腔穿刺成功置入导管后 ,Ⅰ组微泵持续注药 ,首次量 10ml以 1ml/min速度泵入 ,维持量 0 .1ml/min ;Ⅱ组首次量 10ml,5min内分 2次注入 ,5ml/次 ,维持量每隔 6 0min注入 6ml。观察首次量注入后麻醉起效时间、阻滞范围及注药 10min ,15min ,30min ,6 0min ,75min时平均动脉压 (pMA)、心率 (fH)、中心静脉压 (pCV)、血氧饱和度xO2 及心电图 (ECG)变化 ,以及麻醉 1h、术毕、术毕 2 4h皮质醇含量。结果 :注入首次量后 ,麻醉起效时间Ⅰ组较Ⅱ组长 ,阻滞范围 2组比较差异无显著性 (P >0 0 5 )。pMAⅠ组首次量注入后 30min内下降速度缓慢、幅度小 ,维持麻醉期各时点稳定。Ⅱ组注首次量药后 30min内和维持麻醉期每次注药后 15minpMA均显著下降 ,与麻醉前比较差异有极显著性 (P <0 0 1) ,pCV变化与pMA变化相似。Ⅰ、Ⅱ组注药后各时点fH、xO2 、ECG与麻醉前比较差异无显著性。皮质醇含量 2组麻醉前、术毕、术毕 2 4h组间比较差异均无显著性 (

Aim:To observe the anesthesia effect of micropump continuous infusion in epidural block and the influence on hemodynamic and cortisol in patients with neoplasm.Methods:A total of 122 patients (ASAⅠ～Ⅱ,undergoing elective middle and upper abdominal operations)were divided into two groups:Group Ⅰ(micropump continuous infusion, n =61) and Group Ⅱ(interval injection, n =61).The solution of 10 g/L lidocaine and 2.5 g/L Dicaine was used in the two groups.The first dose of 10 ml in Group Ⅰ was epidurally infused at the rate of 1 ml/min and the maintenance dose at 0.1 ml/min.The first dose of 10 ml in Group Ⅱ was epidurally injected twice every 5 min,5 ml for one time,the maintenance dose of 6 ml were epidurally injected at 60 min intervals.We observed the onset time,the extent of block after the first infusion,the changes of p MA , f H, p CV , x O 2 and ECG 10,15,30,60 and 75 min after infusiona,and the blood cortisol content before anesthesia,at the end of operation and 24 h after operation.Results:Compred with those of Gronp Ⅱ,the onset time of Group Ⅰ was longer and the extent of block in group Ⅰ had no significant differences after the first infusion( P >0.05).In Group Ⅰ,the p MA decreased slowly and slightly at 30 min after the 1st dose.During maintenance anesthesia, p MA was stable at each time mentioned.In Group Ⅱ,the p MA decreased markedly both at 30 min after the 1st dose and at 15 min after every maintenance dose of 6 ml injected,which was significantly different from that before anesthesia( P <0.01).The change of p CV was similar to that of p MA .In 2 groups,the f H, x O 2 and ECG had no significant differences than that before anesthesia and after infusion or each injection.In group Ⅰ,the blood cortisol content was not significantly different from that in group Ⅱ before anesthesia at the end of operation and 24 h after operation,but in Gronp Ⅱ that was significantly different at 1 h after anesthesia from that before anesthesia ( P <0.01).Conclusion:Compared with interval injection,the anesthesia effect of micropump continuous infusion had no difference,and the effect on hemodynamics and blood cortisol content is lighte.This anesthesia is safe,effective and feasibl.