中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (7): 647-651.doi: 10.12007/j.issn.0258-4646.2019.07.016

• 论著 • 上一篇    下一篇

不同种类胸段硬膜外局麻药对丙泊酚诱导浓度的影响

韩杰, 王娇, 王品莹, 刘钢, 王俊   

  1. 中国医科大学附属第一医院麻醉科, 沈阳 110001
  • 收稿日期:2018-04-25 出版日期:2019-07-30 发布日期:2019-07-17
  • 通讯作者: 王俊 E-mail:wangjuncmu@hotmail.com
  • 作者简介:韩杰(1989-),女,医师,硕士.

Effects of Thoracic Epidural Anesthesia with Different Local Anesthetics on the Concentration of Propofol in Propofol-induced Anesthesia

HAN Jie, WANG Jiao, WANG Pinying, LIU Gang, WANG Jun   

  1. Department of Anesthesiology, The First Hospital, China Medical University, Shenyang 110001, China
  • Received:2018-04-25 Online:2019-07-30 Published:2019-07-17

摘要: 目的 探讨不同局麻药硬膜外麻醉对清醒状态下脑电双频指数(BIS)值和丙泊酚靶控输注诱导浓度的影响。方法 选择2013年8月至12月于我院拟行肺叶切除术的肺癌患者80例,随机分为4组,每组20例,对照组硬膜外注射生理盐水,3个实验组硬膜外分别注射1%利多卡因、0.25%布比卡因或0.3%罗哌卡因,20 min后丙泊酚靶控输注诱导。记录意识消失时丙泊酚效应室浓度(Ce),硬膜外穿刺前平静状态下、硬膜外给药后20 min、意识消失时以及气管插管前、插管后的平均动脉压、心率、脉搏血氧饱和度(SpO2)、BIS值。结果 硬膜外注药20 min后,实验组BIS值与基础值相比均显著下降(P<0.05),实验组诱导至意识消失时Ce明显低于对照组(P<0.05)。各实验组间的BIS值和Ce均未见明显差异。结论 胸段硬膜外麻醉使清醒状态下BIS值和丙泊酚的诱导浓度下降,不同种类局麻药对丙泊酚诱导浓度的影响无明显差异。

关键词: 靶控输注, 丙泊酚, 局麻药, 脑电双频指数, 胸段硬膜外麻醉

Abstract: Objective To compare the effects of thoracic epidural anesthesia with different local anesthetics on the bispectral index score(BIS)and effect-site concentration(Ce)of propofol in target-controlled infusion(TCI)of propofol. Methods Eighty patients scheduled for lobectomy in The First Hospital of China Medical University from August 2013 to December 2013 were randomly assigned to four groups. The patients in the control group received an epidural injection of normal saline,and those in the experimental groups received an epidural injection of 1% lidocaine,or 0.25% bupivacaine,or 0.3% ropivacaine. Propofol TCI was administered 20 minutes after the epidural injection. Propofol Ce was recorded at the time of loss of consciousness(LOC). Heart rate(HR),invasive blood pressure(IBP),and BIS were recorded at five time points:T0(at baseline),T1(20 min after epidural injection),T2(at LOC),T3(before endotracheal intubation),and T4(1 min after endotracheal intubation). Results Twenty minutes after epidural injection administration,BIS decreased in all experimental groups and was significantly lower than that at the baseline(P<0.05). Propofol Ce at LOC was lower in the experimental groups than in the control group(P<0.05). The differences in BIS and propofol Ce between the three experimental groups were not statistically significant(P>0.05). Conclusion Propofol Ce at LOC and BIS in general anesthesia combined with epidural anesthesia are significantly lower than those in general anesthesia alone,while different local anesthetics has no influence on the propofol Ce.

Key words: target-controlled infusion, propofol, local anesthetics, bispectral index, thoracic epidural anesthesia

中图分类号: 

  • R614.2
[1] SVIRCEVIC V,VAN DIJK D,NIERICH AP,et al. Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery[J]. Anesthesiology,2011,114(2):271-282. DOI:10.1097/ALN.0b013e318201d300.
[2] YANG W,GENG Y,LIU Y,et al. Comparison of effects of thoracic epidural and intravenous administration of lidocaine on target-controlled infusion of propofol and tracheal intubation response during induction of anesthesia[J]. J Cardiothorac Vasc Anesth,2013,27(6):1295-1300. DOI:10.1053/j.jvca.2012.12.020.
[3] SHARIAT MOHARARI R,SAMADI A,IMANI F,et al. The effect of epidural bupivacaine on BIS levels in the awake phase and on the maintenance doses of propofol and fentanyl during general anesthesia[J]. Anesth Pain Med,2013,2(4):149-153. DOI:10.5812/aapm.5461.
[4] LI Y,ZHU S,YAN M. Combined general/epidural anesthesia(ropivacaine 0.375%)versus general anesthesia for upper abdominal surgery[J]. Anesth Analg,2008,106(5):1562-1565. DOI:10.1213/ane.0b013e31816d1976.
[5] SHONO A,SAKURA S,SAITO Y,et al. Comparison of 1% and 2% lidocaine epidural anaesthesia combined with sevoflurane general anaesthesia utilizing a constant bispectral index[J]. Br J Anaesth, 2003,91(6):825-829. DOI:10.1093/bja/aeg266.
[6] KANATA K,SAKURA S,KUSHIZAKI H,et al. Effects of epidural anesthesia with 0.2% and 1% ropivacaine on predicted propofol concentrations and bispectral index values at three clinical end points[J]. J Clin Anesth,2006,18(6):409-414. DOI:10.1016/j.jclinane.2006.01.004.
[7] SONG JC,SUN YM,YANG LQ,et al. A comparison of liver function after hepatectomy with inflow occlusion between sevoflurane and propofol anesthesia[J]. Anesth Analg,2010,111(4):1036-1041. DOI:10.1213/ANE.0b013e3181effda8.
[8] LERMAN J. Study design in clinical research:sample size estimation and power analysis[J]. Can J Anaesth,1996,43(2):184-191. DOI:10.1007/BF03011261.
[9] WANG ZX,HUANG CY,HUA YP,et al. Dexmedetomidine reduces intestinal and hepatic injury after hepatectomy with inflow occlusion under general anaesthesia:a randomized controlled trial[J]. Br J Anaesth,2014,112(6):1055-1064. DOI:10.1093/bja/aeu132.
[10] GLASS PS,BLOOM M,KEARSE L,et al. Bispectral analysis measures sedation and memory effects of propofol,midazolam,isoflurane, and alfentanil in healthy volunteers[J]. Anesthesiology,1997,86(4):836-847.
[11] EAPPEN S,KISSIN I. Effect of subarachnoid bupivacaine block on anesthetic requirements for thiopental in rats[J]. Anesthesiology, 1998,88(4):1036-1042.
[12] HODGSON PS,LIU SS,GRAS TW. Does epidural anesthesia have general anesthetic effects? a prospective,randomized,double-blind, placebo-controlled trial[J]. Anesthesiology,1999,91(6):1687-1692.
[13] POLLOCK JE,NEAL JM,LIU SS,et al. Sedation during spinal anesthesia[J]. Anesthesiology,2000,93(3):728-734. DOI:10.1097/00000542-200009000-00022.
[14] ENT RK M,G YETMEZ B, ZKAN-SEYHAN T,et al. Comparison of the effects of thoracic and lumbar epidural anaesthesia on induction and maintenance doses of propofol during total i.v. anaesthesia[J]. Br J Anaesth,2008,101(2):255-260. DOI:10.1093/bja/aen160.
[15] BEN-SHLOMO I,TVERSKOY M,FLEYSHMAN G,et al. Hypnotic effect of i.v. propofol is enhanced by i.m. administration of either lignocaine or bupivacaine[J]. Br J Anaesth,1997,78(4):375-377.
[16] GINOSAR Y,WEINIGER CF,KURZ V. Sympathectomy-mediated vasodilatation:a randomized concentration ranging study of epidural bupivacaine[J]. Can J Anaesth,2009,56(3):213-221. DOI:10.1007/s12630-008-9036-z.
[17] ISHIYAMA T,OGUCHI T,ⅡJIMA T,et al. Ephedrine,but not phenylephrine,increases bispectral index values during combined general and epidural anesthesia[J]. Anesth Analg,2003,97(3):780-784. DOI:10.1213/01.ANE.0000073355.63287.E4.
[1] 郭丽丽, 姜艳华, 田阿勇. 七氟醚与丙泊酚对经皮肾镜取石术后肾功能及认知功能的影响[J]. 中国医科大学学报, 2019, 48(5): 414-416,424.
[2] 穆莹,刘丽丹,梁晨曦,冯静,张宁,吴秀英. 闭环与开环靶控输注在妇科腔镜手术中的应用比较[J]. 中国医科大学学报, 2017, 46(8): 746-749.
[3] 冯艳,魏芳. 槲皮素对丙泊酚麻醉术后小鼠认知功能的影响及其机制[J]. 中国医科大学学报, 2016, 45(9): 801-804.
[4] 万静洁,李真,金宁,滕秀飞,张焕焕,朱俊超. 小剂量七氟醚或笑气复合丙泊酚对宫腔镜术后恶心呕吐的影响[J]. 中国医科大学学报, 2016, 45(1): 77-79.
[5] 李真,金宁,万静洁,李阳,万玉骁,朱俊超. 脑电双频指数监测小儿丙泊酚复合瑞芬太尼静脉麻醉维持剂量的临床研究[J]. 中国医科大学学报, 2016, 45(1): 17-20.
[6] 高光洁,乔娇,宋丹丹. 儿童全凭静脉麻醉在脑电双频指数指导下气管拔管的临床观察[J]. 中国医科大学学报, 2015, 44(7): 614-617.
[7] 金宁, 李真, 黄昕, 万静洁, 滕秀飞, 朱俊超. 丙泊酚闭环靶控输注系统在小儿耳鼻喉手术中的应用[J]. 中国医科大学学报, 2015, 44(10): 873-976.
[8] 周南,赵芳坤,周锦. 右美托咪啶对老年颅内肿瘤手术患者麻醉诱导期血流动力学和脑电双频指数的影响[J]. 中国医科大学学报, 2014, 43(9): 818-820.
[9] 陈宏志,刘妍雨. 瑞芬太尼与丙泊酚合剂在降低全麻患者气管插管反应的效果观察[J]. 中国医科大学学报, 2013, 42(7): 641-643.
[10] 尹红,陈卫民,朱俊超,洪涛. 兔颈内动脉不同浓度丙泊酚输注药效学研究[J]. 中国医科大学学报, 2013, 42(6): 551-556.
[11] 刘陆陆,吕黄伟. 不同剂量右美托咪定对靶控麻醉丙泊酚Cp50的影响[J]. 中国医科大学学报, 2013, 42(4): 344-346.
[12] 罗小秀,吴秀英. 不同剂量右美托咪啶复合丙泊酚全凭静脉麻醉用于妇科腹腔镜手术的临床观察[J]. 中国医科大学学报, 2013, 42(2): 179-182.
[13] 贾慧,裴凌. 靶控输注和手控输注丙泊酚在喉罩应用中的对比[J]. 中国医科大学学报, 2013, 42(10): 931-931.
[14] 龙波,柴军,李妍,陈卫民. 无痛技术在老年患者结肠镜检查中的应用[J]. 中国医科大学学报, 2012, 41(9): 847-849.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 贺雪梅, 熊欣, 邹建中, 李发琪, 龚晓波. 超声消融剂量与生物学焦域特征[J]. 中国医科大学学报, 2009, 38(9): 654 .
[2] 尹玉, 赵卫华, 胡健. 替米沙坦与非诺贝特对高脂饮食大鼠血清脂联素水平的影响[J]. 中国医科大学学报, 2009, 38(9): 674 .
[3] 孔静, 吴硕东, 范莹, 金俊哲, 石刚. 腹腔镜胰体尾切除及胰腺假性囊肿内引流手术体会[J]. 中国医科大学学报, 2009, 38(9): 690 .
[4] 郭哲, 徐冰, 卢利. 下颌骨髁突骨折治疗的Meta分析[J]. 中国医科大学学报, 2009, 38(9): 709 .
[5] 夏永辉, 徐克. 对吻式支架置入术治疗Leriche综合征15例体会[J]. 中国医科大学学报, 2009, 38(9): 714 .
[6] 张丽, 齐瑞群, 孙艳, 陈国红, 任宏伟, 陈洪铎, 高兴华. 卡介菌多糖核酸对特应性皮炎外周血CLA~+T细胞表达不同细胞因子的影响[J]. 中国医科大学学报, 2009, 38(10): 764 .
[7] 侯怡, 魏薇, 董静, 王毅, 陈杰. 碘缺乏和甲状腺功能减退对大鼠仔鼠内嗅皮质钙调蛋白表达的影响[J]. 中国医科大学学报, 2009, 38(11): 804 .
[8] 蔡鑫泽, 顾卉, 刘彤, 李丰. hLMO1编码基因重组质粒的构建及蛋白的表达和定位[J]. 中国医科大学学报, 2009, 38(11): 816 .
[9] 张华, 王秋月, 侯刚, 许惟元, 李猛, 康健. 辽宁部分农村地区居民吸烟情况与COPD患病关系的调查[J]. 中国医科大学学报, 2009, 38(11): 855 .
[10] 黄海能, 罗起胜, 赵邦, 谭源福, 邓元央, 黄华东, 符黄德, 李传玉. 兔脑创伤后早期血清β淀粉样前体蛋白动态变化的实验研究[J]. 中国医科大学学报, 2010, 39(1): 22 .

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA