【摘要】 目的观察异丙酚靶控输注不同目标血药浓度,辅助硬膜外麻醉清醒镇静的临床效果。方法45例ASA分级Ⅰ～Ⅱ级,行子宫切除术患者,随机分为3组,Ⅰ组作为对照组,单纯硬膜外麻醉,不使用辅助药;Ⅱ组在硬膜外麻醉平面确定即刻设定异丙酚靶控输注目标血药浓度1.0μg/ml,Ⅲ组目标血药浓度为1.5μg/ml,记录从术前到术毕不同时点的心率(HR)及血压(BP),并在术中子宫切除及术毕时刻进行警觉/镇静(0AA/S)评分,同时观察有无内脏牵拉反应及术后知晓情况。结果各组血压在硬膜外麻醉平面确定时明显降低,Ⅱ、Ⅲ组在泵注异丙酚5min较对照组明显降低;各组心率随手术进程逐渐降低,组间无显著差异;Ⅱ组仅有53.3%病人入睡,对术中探查所致内脏牵拉反应的抑制率为53.3%,术中知晓率为33.3%,Ⅲ组病人均入睡,且绝大多数病人在术中仅对轻推动有反应,对术中探查时内脏牵拉反应的抑制率达86.7%,术中知晓率为0。结论异丙酚静脉靶控输注辅助硬膜外麻醉镇静效果确切,且能显著抑制术中探查所致的内脏牵拉反应;且OAA/S镇静评分表明异丙酚目标血药浓度1.5μg/ml镇静效果明显优于目标血药浓度1.0μg/ml。更多还原

【Abstract】 Objective:To observe the sedative effect of epidural anesthesia assisted with target controlled infusion(TCI) propofol.Methods:45 ASA Ⅰ～Ⅱ patients,who would accept hysterectomy,were randomly allocated to group Ⅰ (without propofol),group Ⅱ(Target blood propofol concentration was set at 1.0μg/ml when epidural anesthesia level was confirmed) and group Ⅲ(Target blood propofol concentration was set at 1.5μg/ml).Heart rate and blood pressure were determined at the different moment from pre-operation to the end of the surgery.And the sedation degree was evaluated by the Observer’s Assessment of Alertness/Sedation (OAA/S) Scale.At the same time,efficacy of antitraction response and perioperative awareness were investigated.Results:In three groups,blood pressure significantly decreased when epidural anesthesia level was confirmed.Goup Ⅱ and Goup Ⅲ showed significantly lower than group Ⅰ in 5 min after propofol infusion.HR gradually decreased with operative courses,and no difference was significantly found in the three groups.53.3% of patients fell asleep;53.3% had effective antitraction response and 33.3% were aware in group Ⅱ.And the patients in goup Ⅲ all fell asleep;86.7% could prevent traction response during operation but no perioperative awareness.Conclusion:Target controlled infusion of propofol as an adjuvant for epidural anesthesia is applicable and can prevent viscus traction response during surgical exploration.And the sedative effects of blood propofol concentration of 1.5μg/ml are better than 1.0μg/ml through OAA/S Scale.更多还原