腰段硬膜外阻滞对静脉靶控输注麻醉的影响

目的观察腰段硬膜外阻滞对丙泊酚-舒芬太尼靶控输注（TCI）全凭静脉麻醉的影响。方法将40例ASAⅠ～Ⅱ级行全子宫切除术及要求术后硬膜外镇痛患者分为硬膜外阻滞复合全身麻醉组（GE组）及单纯全身麻醉组（GS组），各20例。L1～L2或L2～L3硬膜外穿刺置管后，GE组硬膜外腔注入2％利多卡因8～10mL，GS组注入等量0．9％氯化钠注射液。全身麻醉深度通过调节内泊酚和舒芳太尼效应室浓度（Ce）维持脑电双频指数（BIS）在40～60范围及血流动力学的稳定。记录麻醉诱导、维持及恢复期相应时间点BIS和Ce值，并计算各药用量。结果丙泊酚Ce及用量两组间差异无统计学意义（P〉0．05）。与GS组相比，GE组麻醉维持和恢复期舒芬太尼Ce均低（P〈0．05）。GE组舒芬太尼用量少于GS组（P〈0．01）。结论腰段硬膜外阻滞复合静脉麻醉时，对全身麻醉镇静成分影响较轻，但明显减少对镇痛成分的需要。

Effects of lumbar epidural block on the intravenous anesthesia under a target-controlled infusion mode

Objective To observe the effects of lumbar epidural lidocaine on the propofol and sufentanil total intravenous anesthesia （TIVA） under a target-controlled infusion （TCI） mode. Methods Forty ASAⅠ～Ⅱ patients scheduled for hysterectomy were randomly allocated to GE group（general anesthesia＋epidural anesthesia） and GS group（general anesthesia＋epidural narmal saline）, with 20 patients in each group. After an epidural catheter was placed at L1-L2 or L2 - L3 interspace, 8 - 10mL of 2% lidocaine was administrated via epidural catheter in group GE and equal volume of saline in group GS. During anesthetic maintenance, propofol effect-site concentration （Ce） was titrated to maintain a target bispectral index （BIS） of 40 - 60, whereas sufentanil Ce was adapted to haemodynamic stability. BIS and predicted Ces of pmpofol and sufentanil were recorded at the corresponding time points. Total consumptions of propofol and sufentanil were calculated per patient. Results Neither the propofol Ces nor the consumption was significantly different between the two groups. In group GE, the sufentanil Ces were significantly decreased compared to that of group GS （P 〈 0.05）, and the consumption was also significantly reduced by approximately 27% compared to that of group GS （P=0.001）.Conclusion Lumbar epidural blockade has little sparing effect on the requirement of sedation, but significantly decreases the requirement of analgetics for an adequate anesthesia.