Objective To investigate the optimal concentration of ropivacaine for epidural anesthesia combined with general anesthesia in esophageal carcinoma radical surgery.Methods Totally 80 patients admitted for esophageal carcinoma radical operation from January to October 2015 in the Affiliated Hospital of Inner Mongolia Medical University were randomly allocated to ropivacaine 0.25％ (group A,20 cases),0.20％ (group B,20 cases),0.15％ (group C,20 cases) and 0.10％ (group D,20 cases) for epidural anesthesia.All patients were administrated ropivacaine 5 ml as the test dose.General anesthesia induction was started after epidural anesthesia took effect;then all patients were epidural administrated ropivacaine,the initial dose was 8 ml and the maintenance dose was 5 ml with l h intervals.General anesthesia was maintained by propofol and remifentanil;the bispectral index value was controlled within 40-60.Ephedrine,dopamine and phenylephrine were used to maintain the mean arterial pressure(MAP) ＞ 60 mmHg.Heart rates,systolic blood pressure,diastolic blood pressure and MAP were recorded at different time points,including the baseline,5 min after administrating test dose (5 ml),5 min after intubation,10 min after the first maintenance dose(8 ml),skin incision,10 min after the second maintenance dose(5 ml) and extubation.Dosages of vasoactive drugs and anesthetic drugs,extubation time and the score of visual analogue scale(VAS) after operation were recorded.Results Heart rates,systolic blood pressures,diastolic blood pressures and MAP at 10 min after the first maintenance dose,skin incision,l0 min after the second maintenance dose and extubation were significantly lower than the baselines in 4 groups(P ＜ 0.05);the heart rate,systolic blood pressure and MAP in group D were significantly higher than those in group A,B,C(P ＜0.05).Group A,B used ephedrine,dopamine,noradrenaline and group C,D used ephedrine,phenylephrine for vasoactivity during operation;the dosage of ephedrine in group D was significantly lower than those in group A,B,C[(6.7 ±3.8)mg vs (15.2 ±3.1),(14.6 ±2.8),(14.3 ±2.4)mg] (P＜0.05);the dosage of dopamine in group B was significantly lower than that in group A [(22 ± 4) mg vs (37 ± 6) mg] (P ＜ 0.05);the dosages of phenylephrine in group A,B,C,D were (957 ± 23),(510 ± 18),(205 ± 15),(81 ± 17) μg,respectively,there were significant differences among 4 groups(P ＜0.05).The dosage of propofol in group D was significantly higher than those in groupA,B,C[(1 036±26)mg vs (732±26),(708±25),(722±22)mg](P＜0.05);there was no significant difference of remifentanil and rocuronium dosages among 4 groups (P ＞ 0.05).There was no significant difference of VAS score among 4 groups (P ＞ 0.05).Conclusion 0.15％ ropivacaine can block thoracic nerve and stabilize hemodynamics;it is the optimal concentration for epidural anesthesia combined with general anesthesia in thoracic surgery.%目的 探究连续硬膜外麻醉复合全身麻醉食管癌根治术中罗哌卡因的最适浓度.方法 选取2015年1-10月于内蒙古医科大学附属医院拟采用连续硬膜外麻醉复合全身麻醉行侧开胸食管癌根治术的患者80例,采用随机数字表法将患者按硬膜外用药浓度分为4组,每组20例.A组硬膜外麻醉使用罗哌卡因浓度为0.25％;B组罗哌卡因浓度为0.20％;C组罗哌卡因浓度为0.15％;D组罗哌卡因浓度为0.10％.4组均行第8～10胸椎间隙硬膜外穿刺,头向置管4 cm,各组给予相应浓度的罗哌卡因试验剂量5 ml,确定硬膜外麻醉有效并排除异常阻滞情况后开始全身麻醉诱导.各组硬膜外给予对应浓度首次维持剂量8 ml,术中每lh追加维持剂量5 ml.全身麻醉维持采用静脉持续输注丙泊酚和瑞芬太尼,使脑电双频指数值保持在40～60.术中酌情给予麻黄素、多巴胺、去氧肾上腺素,以维持平均动脉压(MAP)＞60 mmHg(1 mmHg =0.133 kPa).记录并比较4组入室时、给予试验剂量(5 ml)后5 min、插管后5 min、给予首次维持剂量(8 ml)后10 min、切皮时、给予第2次维持剂量(5 ml)后10 min以及拔管时的心率、收缩压、舒张压和MAP,记录血管活性药物的种类及用量、全身麻醉药物用量、清醒拔管时间以及术后疼痛视觉模拟量表(VAS)评分.结果 4组患者在给予首次维持剂量后10 min、切皮时、给予第2次维持剂量后10 min和拔管时的心率、收缩压、舒张压和MAP均低于入室时,D组的心率、收缩压和MAP均高于A、B、C组,差异均有统计学意义(均P＜0.05).A、B组血管活性药物应用麻黄素、多巴胺和去氧肾上腺素,C、D组应用麻黄素和去氧肾上腺素.A、B、C组麻黄素用量比较,差异无统计学意义(P＞0.05),D组麻黄素用量低于A、B、C组[(6.7±3.8)mg比(15.2±3.1)、(14.6±2.8)、(14.3±2.4)mg],B组多巴胺用量低于A组[(22±4) mg比(37±6) mg],A、B、C、D组去氧肾上腺素用量逐一减少[(957±23)、(510±18)、(205±15) μg比(81±17) μg],差异均有统计学意义(均P＜0.05).D组丙泊酚用量高于A、B、C组[(1 036±26) mg比(732±26)、(708±25)、(722±22) mg],差异均有统计学意义(均P＜0.05);4组瑞芬太尼、罗库溴铵用量比较,差异均无统计学意义(均P ＞0.05).4组患者拔管时间和出室前动、静态VAS评分比较,差异均无统计学意义(均P＞0.05).结论 0.15％的罗哌卡因足以阻断胸部的交感与感觉神经,能够稳定血流动力学,是复合全身麻醉完成胸科手术的最适硬膜外用药浓度.
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