罗哌卡因硬膜外阻滞对丙泊酚TCI时BIS的影响

摘要

目的 探讨罗哌卡因(ropivacaine,RPC)硬膜外用药后对胃肠肿瘤手术患者全麻诱导期丙泊酚靶控输注(TCI)时脑电双频指数(BIS)的影响及机制.方法 40例患者随机分为硬膜外生理盐水组(GC)和硬膜外RPC组(GR),硬膜外穿刺置管成功后连接BIS,设定丙泊酚TCI的效应室浓度2.5μg/mL维持麻醉,手术开始前15 min硬膜外给药,GC组用0.9％的生理盐水,GR组用0.75％的RPC,首次剂量10ml,然后以5 ml/h持续硬膜外注射,记录患者麻醉维持时的BIS值.结果 清醒状态两组BIS值差异无显著性(P＞0.05),手术后GC组30 min BIS值平均85.46、GR组BIS值平均80.33,60 min GC组BIS值80.19、GR组BIS值72.51,两组患者BIS值显著降低(P＜0.05).结论 硬膜外RPC阻滞显著降低丙泊酚TCI麻醉时的BIS值,增强了镇静深度,可适度减少丙泊酚的用量,提高手术的安全性.%Objective To investigate the impact and mechanism of ropivacaine epidural anesthesia on the values of bispectral index (BIS) in patients with gastrointestinal tumors when propofol target-controlled infusion (TCI).Methods 40 patients were randomly divided into the epidural saline group (GC) and epidural RPC Group (GR),after the success of epidural catheterization connection BIS,set the TCI propofol effect-site concentration 2.5 μg/mL to maintain anesthesia,epidural administration at 15 min before surgery,GC group with 0.9％ saline,GR group with 0.75％ of the RPC.The first dose was 10 ml,then 5 ml/h continuous epidural injection recorded the BIS values.Results Two awake group showed no significant difference in BIS values(P＞0.05),BIS 30 min after operation in group GC,group GR values by an average of 85.46,BIS average of 80.33 of GR group,BIS 80.19 for 60 min GC group,BIS 72.51 for GR group,BIS of patients in two groups significantly reduced (P＜0.05).Conelusion Ropivacaine epidural anesthesia significantly can reduce the BIS values with propofol TCI, enhance the depth of sedation.It may be appropriate to reduce the amount of propofol and inprove the safety of operation.