老年患者罗哌卡因硬膜外阻滞对全麻诱导期异丙酚TCI镇静催眠作用的影响

目的:评价罗哌卡因硬膜外用药后对老年患者全麻诱导期异丙酚靶控输注(TCI)时镇静催眠作用的影响,并探讨其可能的机制。方法:病人分为罗哌卡因组(GR,n=20)和对照组(GS,n=20),分别采用0.5%罗哌卡因和生理盐水硬膜外给药。测定病人感觉阻滞平面和运动神经阻滞程度,随后用异丙酚TCI输注全麻诱导,记录病人意识消失所需的时间、异丙酚效应室浓度(Ce)及用量。结果:意识消失所需时间GR组比GS组快约20%(P<0.05);GR组的异丙酚效应室浓度(Ce)、用量均比GS组显著为低(P<0.05);两组病人的基础BIS值,硬膜外用药15min后、意识消失时、插管时及插管后BIS值均无显著性差异(P>0.05);两组病人意识消失时BIS值与基础值相比有显著性差异(P<0.05)。GR组MAP在硬膜外用药15min、意识消失时、插管后1min,与GC组相比有显著性差异(P<0.05)。结论:老年患者全麻诱导期BIS监测下异丙酚TCI输注复合硬膜外阻滞,可明显减少异丙酚的用量,缩短意识消失所需时间,减轻插管反应,降低全麻药可能引起的副作用。

Influences of Ropivacaine in Epidural Anesthesia on Effects of Propofol Target-controlled Infusion during Induction of General Anesthesia in Elderly Patients

Objective:To observe influences of ropivacaine in epidural anesthesia on effects of propofol target-controlled infusion during induction of general anesthesia in elderly patients,and to discuss the probably mechanism.Methods:Forty elderly patients were randomly divided into two groups: ropivacaine group(GR,n=20)and physiological saline control group(GS,n=20).Patients in the two groups were given 0.5%ropivacaine(GR)and physiological saline(GS)for epidural anesthesia respectively,observing the efficacy of sensory and motor block.Target controlled infusion of propofol during induction of general anesthesia,time of consciousness disappear,propofol diprivan concentration and the doses of propofol were recorded.Results: Time of consciousness disappear in ropivacaine group was 20% less than physiological saline group(P<0.05).Propofol diprivan concentration and dose in ropivacaine group were lower than control group(P<0.05).There was no significant difference between the two groups in the basal BIS value,BIS value 15 minutes after epidural injection,during consciousness disappear,the BIS value during and after tracheal intubations(P>0.05).There were significant discrepancy in basal BIS value and the BIS value during consciousness disappear in two groups(P<0.05).The MAP value 15 minutes after epidural injection,during consciousness disappear and 1 min after tracheal intubations in ropivacaine group were lower,compared with control group(P<0.05).Conclusion: Propofol target-controlled infusion epidural anesthesia during induction of general anesthesia combined epidural anesthesia in elderly patients can be significantly decrease the dose of propofol and time of consciousness disappear,suppress the response to tracheal intubation and debase the possible side-effect of general anesthesia drugs.