硬膜外麻醉复合丙泊酚靶控输注镇静在盆底重建术中的应用

Application of epidural anesthesia combined with propofol sedation performed by targeted concentration infusion in patients undergoing total pelvic floor reconstruction surgery

目的观察丙泊酚靶控输注镇静复合硬膜外麻醉在中老年盆底功能障碍患者盆底重建术中的应用。方法选择因盆底功能障碍拟于硬膜外麻醉下行盆底重建术的患者80例,采用随机数字表法将患者分为研究组(n=40)及对照组(n=40)。两组患者均行腰2~3椎间隙硬膜外穿刺置管麻醉。研究组硬膜外麻醉建立后,采用靶控输注静脉泵注丙泊酚,调整丙泊酚剂量,维持患者脑电双频谱指数(BIS)监测于65~80,改良镇静/警醒评分于3分,持续静脉泵注至术毕封皮。记录两组患者围术期心率(HR)、平均动脉压(MAP);观察研究组患者术中镇静程度、丙泊酚血浆靶控浓度、不良反应发生情况。结果研究组患者硬膜外麻醉镇静后(T1)、手术开始时(T2)、手术开始30min(T3)的HR及MAP低于手术麻醉前(T0)、术后30min(T4),差异有统计学意义(P<0.05),对照组T2、T3的HR及MAP高于T0、T4(P<0.05),研究组患者围术期T1、T2、T3的HR及T2的MAP低于对照组(P<0.05);研究组有2例患者发生呼吸抑制;研究组寒战发生率低于对照组(P=0.014),其余不良反应发生率差异无统计学意义(P>0.05),研究组患者BIS维持于(73.3±4.8)^(76.1±3.4),丙泊酚血浆靶控浓度范围为(1.32±0.29)μg/mL^(1.52±0.26)μg/mL。结论丙泊酚靶控输注镇静复合硬膜外麻醉可应用于中老年盆底功能障碍患者盆底重建手术。

Objective To evaluate the feasibility of combining the sedation performed by propofol targeted concentration infusion with epidural anesthesia in patients undergoing total pelvic floor reconstruction.Methods A total of 80 eligible patients were recruited and were assigned randomly into the study group（n=40）and the control group（n=40）.All patients in both groups were administered epidural anesthesia with the puncture and catheter placing in the space between the 2nd-3rd lumbar vertebras.After the epidural anesthesia,patients in the study group were administered propofol by targeted concentration infusion（TCI）system.The plasma concentration of propofol was modulated to obtain the BIS maintaining between 65-80,and the OAA/S maintaining at3 scores.The propofol was continuously infused until closing the incision.Values of HR,MAP at different time points in the operation were recorded,and the plasma concentrations of propofol,the incidences of adverse events were recorded.Results The HR and MAP of patients in the study group decreased at T1（given the anesthetic）,T2（the beginning of the operation）,T3（the beginning of the operation）,compared with those at T0（before the anesthetic）and T4（30min after the operation）（P〈0.05）.The HR and MAP of patients in the control group elevated at T2,T3,compared with those at T0 and T4（P〈0.05）.The HR of study group at T1,T2,T3 and the MAP at T2 were lower than those in control group.In study group,two asphyxia patients were founded.The incidence of shivering in the study group was lower than that in control group（P=0.014）.No statistical difference was found in the incidences of other adverse event between this two groups（P〉0.05）.BIS of study group was（73.3±4.8）-（76.1±3.4）,and the plasma concentrations of propofol was（1.32±0.29）μg/mL-（1.52±0.26）μg/mL.Conclusion The combination of propofol sedation performed by TCI and epidural anesthesia could be safely and effectively used in patients undergoing total pelvic floor reconstruction.