不同镇静方法在老年人硬膜外麻醉中的可行性及安全性研究

目的:研究老年人硬膜外麻醉中不同镇静方法的安全性及可行性。方法:75例择期于硬膜外麻醉下行改良乳癌根治术的老年患者随机分为3组,氟杜组(A组,n=25),咪达唑伦组(B组,n=25)及丙泊酚组(C组,n=25)。分别于麻醉前、意识消失时、切皮时及消除腋窝淋巴结时测定BIS值,HR、SBP、DBP、RR、PetCO2及皮质醇浓度,及相应时点OAA/S评分。结果:A组BIS值处于睡眠状态,PetCO2、SBP、DBP与术前相比无显著变化(P>0.05),B组BIS值较A组下降明显(P<0.05),但伴有HR、SBP、RR、DBP降低(P<0.05)及PetCO2升高(P<0.05),C组BIS值处于麻醉状态,但HR、SBP、RR、DBP、皮质醇下降较术前及A、B两组明显(P<0.05)。结论:A组镇静方法不能消除术中应激及术后回忆,B组不能消除术中应激但无术后回忆,C组可完全消除术中应激及术后回忆,但伴有较明显的循环呼吸功能抑制。

The feasibility and reliability study of different conscious-sedation methods during epidural anesthesia in old patients

Objective: To study the feasibility and reliability of different conscious-sedation methods during epidural anesthesia in old patients. Methods: 75 cases subject to selective modified radical mastectomy under epidural anesthesia were randomly divided into 3 groups: Droperidol and pethidine group(group A, n=25) , midazolam group(group B, n=25), propofol group(group C, n=25). The HR,SBP, DBP, RR,PetCO2, concentration of hydrocortisone and BIS value were recorded and the OAA/S score were obtained respectively at the time of pre-anesthesia, conscious loss, operation initiation and axillary lymph node clearing. Results: In group A, the BIS value was in sleepy condition. PetCO2, SBP, DBP were not different compared with pre-operation(P>0.05). In group B, the BIS value decreased obviously compared with group A(P<0.05), with HR, SBP, RR, DBP decreased(P<0.05) and PetCO2 increased(P<0.05). The BIS value of group C was in drugged state and HR, SBP, DBP, RR, concentration of hydrocortisone decreased more obviously than group A and B(P<0.05). Conclusion: Group A could not preclude stress during operation and palinmnesis after operation. Group B could not preclude stress during operation but could preclude palinmnesis after operation was absent. Group C could preclude stress during operation and palinmnesis after operation completely, but the respiratory and circulatory inhibition was obvious.