【摘要】 目的　探讨硬膜外阻滞对异丙酚全麻诱导用量的影响及相应脑电监测参数的变化。方法　 30例择期行上腹部手术病人 ,随机分为硬膜外复合全麻组 (GE)和全麻组 (G) ,每组 15例。异丙酚输注通过TCI系统(Diprifusor)进行 ,以预期血浆药物浓度为靶控目标 ,最初设定目标血药浓度为 1.0 μg/mL ,以后每 3min递增0 .2μg/mL ,直至OAA/S(镇静 /醒觉评分 )从 5分 (清醒 )降至 1分 (对轻推无反应 )。每次调整目标血药浓度前行OAA/S评分 ,并记录即时的异丙酚预期效应室浓度 (ce)、BIS、AAI、MAP、HR和SPO2 。结果　OAA/S评分从 5分到 1分时所需异丙酚预期ceGE组较G组为低 ,在 1分水平时差异有统计学意义 (P <0 .0 5 )。AAI和BIS值随着镇静程度的加深逐渐下降 ,与OAA/S评分之间的相关性较好 ;在相同OAA/S评分水平时 ,两组的AAI和BIS值水平无显著差异 (P >0 .0 5 )。AAI和BIS值与异丙酚预期ce之间呈直线负相关。结论　硬膜外阻滞可以增强异丙酚的镇静催眠作用 ,而数量化脑电参数AAI和BIS在此过程中仍能较准确地反映麻醉深度更多还原

【Abstract】 Purpose To investigate the effects of epidural blockade on the induction dose of propofol and the changes of electroencephalographic variables. Methods Thirty patients scheduled for upper abdominal surgeries were randomly divided into two groups: general anesthesia combined with epidural group(GE) and general anesthesia group(G).Target controlled infusion(TCI) of propofol was performed with Diprifusor and expected plasma concentration(cp) was used as target concentration.An initial target concentration of 1.0 μg/mL was chosen and then increased by 0.2 μg/mL every 3 min until observer’s assessment of alertness/sedatin (OAA/S) scale score from 5 to 1.Before each adjustment of target concentration,OAA/S score was evaluated and expected effect-site concentration(ce),bispectral index(BIS),auditory evoked potential index (AAI),MAP,HR and SPO 2 were recorded at the same time. Results From OAA/S score of 5 to 1,the lower ce were needed in Group GE than in Group G,and at OAA/S score of 1,the difference was significant(P<0.05).AAI and BIS decreased following the increase of sedation level and correlated well with OAA/S scores; and at the same OAA/S score,the values of AAI and BIS were not significantly different between groups(P>0.05).There was negative linear correlation between AAI/BIS and ce. Conclusions Epidural blockade can enhance the sedation and hypnotic effect of propofol.AAI and BIS can reflect the depth of sedation well even under the epidural blockade.更多还原