0.375%罗哌卡因硬膜外阻滞对静脉麻醉的影响

［摘要］目的观察0.375%罗哌卡因硬膜外阻滞对静脉麻醉药用量、麻醉诱导和苏醒及机体应激反应的影响。方法选取择期上腹部手术患者32例，双盲随机分为2组：全凭静脉麻醉（TIVA）组16例，靶控输注舒芬太尼、丙泊酚、维库溴铵全凭静脉麻醉； 复合静脉麻醉（EIVA）组16例，在TIVA组的基础上联合0.375%罗哌卡因硬膜外阻滞。根据脑电双频谱指数（BIS）、肌松监测和血流动力学指导用药。记录诱导开始至意识消失和插管的时间，停用丙泊酚至睁眼和拔管的时间，记录丙泊酚、舒芬太尼的麻醉诱导用量和维持量。采血检测血浆肾上腺素、血清皮质醇和血糖浓度，观察血流动力学变化。结果两组丙泊酚和舒芬太尼诱导量、维持量均无明显差异。两组诱导开始至意识消失和插管的时间、停用丙泊酚至睁眼和拔管的时间差异无显著性。两组血糖均于术中和拔管后高于基础值（P＜0.05＝，TIVA组升高较EIVA组明显（P＜0.05＝。术中和拔管后TIVA组血清皮质醇和血浆肾上腺素浓度明显高于EIVA组（P＜0.05＝。术中TIVA组的平均动脉压（MAP）均高于EIVA组（P＜0.05＝，用于降低血压的乌拉地尔用量明显多于EIVA组（P＜0.05＝。结论0.375%罗哌卡因持续硬膜外输注复合静脉麻醉用于上腹部手术明显缓解围术期机体应激反应；维持相同麻醉深度和肌松程度时，不能减少静脉麻醉药的诱导和术中维持用量；不能缩短麻醉诱导意识消失和术后苏醒所需时间。

Effects of Epidural Anesthesia with 0.375% Ropivacaine on the Requirement of Intravenous Anesthetics

Objective To observe the effects of 0.375% ropivacaine epidural anesthesia on the dosage of intravenous anesthetics induction,recovery time,and stress response. Methods Thirty-two patients undergoing selected major abdominal surgery were randomly double-blind allocated into one of two groups: Group TIVA received only intravenous anesthesia with propofol,sufentynl and vecuronium by plasma concentration controlled infusion.Group EIVA,on the basis of group TIVA,0.375% ropivacaine epidural anesthesia was added as a combination.The intravenous anesthetics were delivered according to electroencephalographic bispectyal index(BIS) value,TOF value of muscle paralysis monitor and hemodynamic changes.The dosages of intravenous anesthetics for anesthesia induction and maintenance were recorded.The time interval from the beginning of anesthesia induction to unconsciousness,the time of intubation,the time from stopping propofol to eyes opening,and the time of extubation after operation were observed.Arterial blood sample was collected for determination of plasma glucose,adrenaline,and cortisol.Hemodynamic changes were observed. Results There was no signficant difference in the dosage of propofol and sufentynl for anesthesia induction and maintenance between the two groups.There was no signficant difference between the two groups in time interval from beginning of induction to unconsciousness and intubation,and that from stopping of propofol to eyes opening and extubation.Patients in the two groups had higher plasma glucose during operation and after extubation than the baseline values(P<0.05).During operation and after extubation,patients in group TIVA had higher plasma glucose,adrenaline and cortisol than those in group EIVA(P<0.05).The patients in group TIVA had higher MAP during operation than that in group EIVA(P<0.05),and were given more uradilminto to lower blood pressure(P<0.05). Conclusion When combined with intravenous anesthesia in upper abdominal surgery,0.375% ropivacaine epidural anesthesia can restrain the stress response in perioperative period,but cann't decrease the requirement of intravenous anesthetics for anesthesia induction and maintenance,and cann't shorten the time interval of unconsciousness during induction and that for recovery after operation.