两种椎管内麻醉方式对BIS引导异丙酚镇静效果影响

目的比较两种椎管内麻醉方式对BIS引导异丙酚镇静效果的影响。方法妇科择期开腹手术病人60例,随机分为腰椎硬膜外联合麻醉镇静组（A组）与硬膜外麻醉镇静组（B组）。两组病人均控制无痛阻滞平面T6～T8水平,阻滞平面固定后,异丙酚靶控输注镇静,血浆靶控起始浓度为1.2mg/L,达到预期血浆靶浓度后,每30s上调血浆靶浓度0.2mg/L,使BIS值达到70,术中维持BIS值在65～75范围内。比较两组切皮（T0）、腹腔探查牵拉子宫（T1）、冲洗腹腔（T2）及术毕（T3）异丙酚效应室浓度;比较两组异丙酚镇静初始用量、异丙酚总用量、手术时间、镇静时间;比较两组麻黄碱、阿托品使用率与输液量、出血量。结果与B组比较,A组各时间点异丙酚效应室浓度均明显降低（t=2.201～2.920,P〈0.05）;异丙酚镇静初始用量、异丙酚总用量减少（t=2.473、2.639,P〈0.05）;麻黄碱使用率增高（χ2=9.130,P〈0.05）;两组手术时间、镇静时间、输液量、出血量及阿托品使用率比较差异无显著性（P〉0.05）。结论腰椎硬膜外联合麻醉与硬膜外麻醉相比,可降低BIS引导异丙酚镇静的效应室浓度及用量,具有更明显的镇静作用。

THE INFLUENCE OF TWO MODALITIES OF INTRASPINAL ANESTHESIA ON BIS GUIDED SEDATION WITH PROPOFOL

Objective To compare the effect between two types of intraspinal anesthesia on Bispectral guided sedation with propofol. Methods Sixty patients scheduled for selective gynecological abdominal surgery were randomized to combined spinal-epidural anesthesia sedation group （group A） and epidural anesthesia sedation group （group B）. The analgesia plane in patients in two groups was controlled at between T6 and TS. The TCI of propofol was started at a target plasma concentration of 1.2 mg/L, followed by increments 0.2 mg/L at 30 seconds intervals until the BIS value reaching 70. The BIS was maintained at between 65 and 75 at surgery. The propofol effect-site concentrations at incision, abdominal exploration, traction of uterus, douching of abdominal cavity and at the end of surgery were compared between the two groups. The initial dose and total dose of propofol, operation time, sedation time, the use of ephedrine and atropine, the volume of infusion and blood loss were compared between the twp groups. Results Compared with group B, the propofol effect-site concentrations in each point of time of group A were significantly lowered （t=2. 201--2. 920,P〈0.05） ; the initial and total dose of propofol decreased （t=2. 473, 2. 639;P〈0.05） ; the usage of ephedrine increased （x2= 9. 130,P〈0.05）. There were no significant differences between the two groups in respect of operation time, duration of sedation, volume of transfusion, blood loss at surgery and usage of atropine （P 〉 0. 05）. Conclusion Compared with epidural anesthesia, the combined spinal-epidural may decrease the effect-site concentration of BIS guided sedation with propofol and its dosage, showing much stronger in sedation.