摘要
目的比较硬膜外阻滞分别复合笑气和丙泊酚全麻中的麻醉深度及循环稳定性,探讨其临床意义.方法择期行腹部手术患者60例,年龄20-60岁,ASAⅠ-Ⅱ级,随机分为笑气组（G组）和丙泊酚组（P组）.入室后监测NIBP、ECG、SpO2和BIS指数.开放静脉用胶体液快速扩容500-1000ml,同时选择手术区域相应的间隙行硬膜外穿刺,给予试验量无异常后,根据患者情况及手术范围要求单次注入相应剂量1%利多卡因＋0.33%地卡因混合液.确定硬膜外阻滞平面后开始全麻诱导,依次注入咪唑安定0.04mg/kg、阿曲库胺0.06mg/kg、丙泊酚1-2mg/kg后完成气管插管,G组以大流量比例为2：1的N2O-O2吸入维持麻醉,P组以3mg/kg/h丙泊酚初始计量静脉泵入,术中调节剂量使BIS值维持在50左右.记录病人入室（T1）,插管前（T2）,插管后（T3）,切皮（T4）,术中低值（T5）,术中高值（T6）及清醒拔管（T7）各点的血流动力学（SBP、DBP、HR）、血氧饱和度（SpO2）、BIS的变化.手术结束停止N2O和丙泊酚后病人睁眼,拔管及完全清醒（可正确回答姓名、年龄等简单问题）的时间.P组丙泊酚的用量.术后随访通过以下问题来测试有无术中知晓.结果两组术中血流动力学均平稳,术中SBP、DBP和HR均无显著差异（P〉0.05）.术中P组BIS值显著低于G组（P〈0.05）,但术后睁眼,拔管及完全清醒时间显著长于G组（P〈0.05）.两组术后随访均未发现术中知晓.结论对于腹部手术两种麻醉方法均能保证一定的麻醉深度和血流动力学平稳,对于高龄危重患者,笑气对循环影响较小;而对于一般情况较好的年轻患者,为预防术中知晓的发生,硬膜外阻滞复合丙泊酚全麻是另一很好的选择.
Objective To compare the depth of anesthesia and stability of circulation during general anesthesia associated with epidural anesthesia for abdominal surgery Methods 60 patients endured epigastric operation were divided to 2 groups. They were group G（anesthesia with 66% N2O-O2） and group P（anesthesia with propofol）. ASAⅠ～Ⅱ . After epidural block, the general anesthesia were induced with Midazolam 0.04mg/kg, Atracurium 0.1mg/kg, Propofol 1-2mg/kg, followed by endotracheal intubation. The anesthesia was maintained by 66% N2O-O2. SBP, DBP, HR, SpO2 and BIS were continuously monitored and recorded. All the data obtained were analyzed with ANOVA and independent-sample t test with SPSS 11.5 statistical software. P〈0.05 was considered statistically significant. Result There was no significant difference in SBP, DBP and HR between group G and group P. The BIS in group G was significantly higher than group P. Conclusion The hemodynamic parameters were stable during the combined anesthesia. The BIS during the maintenance of anesthesia of group G was at comparatively high level, which was significantly different from group P. The mechanism needs further research.
出处
《湖南中医药大学学报》
CAS
2016年第A02期745-745,共1页
Journal of Hunan University of Chinese Medicine
关键词
硬膜外阻滞全麻笑气丙泊酚BIS
epidural anesthesia, general anesthesia, N2O, propofol, BIS
