靶控输注舒芬太尼复合丙泊酚联合硬膜外麻醉用于上腹部手术的麻醉效果观察

目的研究靶控输注舒芬太尼复合丙泊酚用于胰腺手术的麻醉效果以及硬膜外0.375%罗哌卡因用于胰腺手术时对血流动力学和舒芬太尼的需求量的影响。方法胰腺手术患者40例,ASAⅠ或Ⅱ级,手术持续时间1.5～4 h,随机分为硬膜外（生理盐水）、舒芬太尼组（S组）和硬膜外（0.375%罗哌卡因）、舒芬太尼组（R组）。全麻诱导采用靶控输注舒芬太尼和丙泊酚,意识消失（呼之不应）后静脉注射罗库溴铵0.6 mg/kg,当BIS值达到40～50时行气管插管,机械通气。气管插管后,调节丙泊酚靶浓度维持BIS在40～50,舒芬太尼靶浓度则根据动脉血压和心率来调节。记录两组入室时（基础值）、插管前即刻、插管后2 min、切皮即刻、剖腹探查即刻、手术1 h、拔管即刻的SBP、DBP、MAP、HR、BIS及舒芬太尼Ce（SCe）与丙泊酚Ce（PCe）。同时记录诱导时舒芬太尼和丙泊酚的总量。结果与S组比较,R组在切皮即刻、剖腹探查即刻、手术1 h、拔管即刻SCe降低（P〈0.05）。与基础值比较,两组插管前即刻、手术1 h、拔管即刻SBP、DBP、MAP、HR均降低（P〈0.05）,两组插管后2 min、切皮即刻、剖腹探查即刻HR均降低（P〈0.05）;与S组比较,R组插管后2 min、切皮即刻、剖腹探查即刻、手术1 h、拔管即刻SBP均降低（P〈0.05）,剖腹探查即刻、手术1 h DBP、MAP均降低（P〈0.05）,插管后2 min、切皮即刻、剖腹探查即刻、手术1 h、拔管即刻HR均降低（P〈0.05）。两组丙泊酚诱导和维持的量相比,差异无统计学意义（P〉0.05）。两组舒芬太尼诱导剂量相比,差异也无统计学意义（P〉0.05）,维持剂量在R组显著减少。结论硬膜外0.375%罗哌卡因能够减轻胰腺手术应激反应,同时减少全麻药舒芬太尼的用量。

Observation on the effect of combined target-controlled infusion of sufentanil-propofol and epidural anesthesia for upper abdominal surgery

Objective To investigate the anesthetic effect of combined target-controlled infusion of snfentanil and propofol for pancreas surgery and the effect of epidural 0. 375% ropivaeaine on haemodynamics and anesthetic requirements of sufentanil for pancreas surgery. Methods Forty adults, ASA physical status Ⅰ- Ⅲ ,undergoing pancreas surgery lasting about 1.5 - 4h were randomly divided into two groups ： epidural （saline） , sufentanil （ group S） and epidural （0.375 % ropivacaine）, sufentanil （ group R） anesthesia. Induction of anesthesia was performed with target-controlled infusion sufentanil and prepofol, given roeuronium 0.6 mg/kg intravenously after anesthesia-induced loss of consciousness, Endotracheal intubation was performed when BIS was between 40 and 50. After intubation, target concentration of propofol was adjusted to maintain BIS between 40 and 50 ; the target concentration of sufentanil was adjusted according to arterial blood pressure and heart rate. SBP, DBP, MAP, HR, BIS, sufentanil Ce （SCe） and propofol Ce （PCe） were recorded at baseline, immediately before intubation, 2min after tracheal intubation, immediately after inci- sion, immediately after the initiation of celiac exploration, lh after operation, and immediately after tracheal extubation in both groups. Meanwhile, the total snfentanil and propofol were recorded. Results SCe were higher at immediately after incision, imme- diately after the initiation of celiac exploration, 1 h after operation, and immediately after tracheal extubation in group S when com- pared with group R （ P 〈 0.05 ） ; SBP, DBP, MAP and HR were decreased at immediately before intubation, 1 h after operation and immediately after tracheal extubation in all groups when compared with baseline; SBP were lower at 2min after tracheal intubation,immediately after incision, immediately after the initiation of celiac exploration, 1 h after operation, and immediately after tracheal extubation in group R when compared with group S（ P 〈 0.05 ） ; DBP,MAP were lower at immediately after the initiation of celiac exploration, 1 h after operation （P 〈 0.05 ） ; HR were lower at 2min after tracheal intubation, immediately after incision, immediately after the initiation of celiac exploration, 1 h after operation, and immediately after tracheal extubation in group R when compared with group S （ P 〈 0.05 ）. The difference between requirements of propofol for induction and maintenance of anesthesia showed no statistical significance （ P 〉 0.05 ） ; the difference between requirements of sufentanil in two groups showed no statistical significance （P 〉 0.05 ）. Conclusion 0.375% epidural ropivacaine can suppress stress responses and sufentanil requirements during pancreas surgery.