硬膜外麻醉复合丙泊酚靶控输注镇静在盆底重建术中的应用

发布时间：2018-12-27 16:27

【摘要】：目的观察丙泊酚靶控输注镇静复合硬膜外麻醉在中老年盆底功能障碍患者盆底重建术中的应用。方法选择因盆底功能障碍拟于硬膜外麻醉下行盆底重建术的患者80例,采用随机数字表法将患者分为研究组(n=40)及对照组(n=40)。两组患者均行腰2~3椎间隙硬膜外穿刺置管麻醉。研究组硬膜外麻醉建立后,采用靶控输注静脉泵注丙泊酚,调整丙泊酚剂量,维持患者脑电双频谱指数(BIS)监测于65~80,改良镇静/警醒评分于3分,持续静脉泵注至术毕封皮。记录两组患者围术期心率(HR)、平均动脉压(MAP);观察研究组患者术中镇静程度、丙泊酚血浆靶控浓度、不良反应发生情况。结果研究组患者硬膜外麻醉镇静后(T1)、手术开始时(T2)、手术开始30min(T3)的HR及MAP低于手术麻醉前(T0)、术后30min(T4),差异有统计学意义(P0.05),对照组T2、T3的HR及MAP高于T0、T4(P0.05),研究组患者围术期T1、T2、T3的HR及T2的MAP低于对照组(P0.05);研究组有2例患者发生呼吸抑制;研究组寒战发生率低于对照组(P=0.014),其余不良反应发生率差异无统计学意义(P0.05),研究组患者BIS维持于(73.3±4.8)~(76.1±3.4),丙泊酚血浆靶控浓度范围为(1.32±0.29)μg/mL~(1.52±0.26)μg/mL。结论丙泊酚靶控输注镇静复合硬膜外麻醉可应用于中老年盆底功能障碍患者盆底重建手术。
[Abstract]:Objective to observe the effect of target controlled infusion of propofol combined with epidural anesthesia on pelvic floor reconstruction in middle-aged and aged patients with pelvic floor dysfunction. Methods 80 patients with pelvic floor reconstruction due to pelvic floor dysfunction were randomly divided into study group (n = 40) and control group (n = 40). The patients in both groups were anesthetized by epidural puncture in lumbar intervertebral space. After epidural anesthesia was established in the study group, propofol was injected by target-controlled intravenous infusion to adjust the dose of propofol. The bispectral index (BIS) of EEG was monitored at 650.The improved sedation / alertness score was 3 points. Continuous intravenous pump until the end of the skin closure. The perioperative heart rate (HR), mean arterial pressure (MAP);) was recorded to observe the degree of sedation, plasma target control concentration of propofol and adverse reactions in the study group. Results after epidural anesthesia (T1), at the beginning of operation (T2), the HR and MAP of 30min (T3) at the beginning of operation were lower than those before anesthesia (T0), and 30min after operation (T4) were significantly lower than those in control group (P0.05). The HR and MAP of T3 were higher than that of T0T4 (P0.05). The HR and MAP of T2T3 in the study group were lower than those in the control group (P0.05). There were 2 cases of respiratory depression in the study group. The incidence of shivering in the study group was lower than that in the control group (P0. 014). There was no significant difference in the incidence of other adverse reactions (P0.05). The BIS of the patients in the study group was maintained at (73.3 卤4.8) ~ (76.1 卤3.4). The plasma target controlled concentration of propofol was (1.32 卤0.29) 渭 g / mL ~ (1.52 卤0.26) 渭 g / mL. Conclusion Target controlled infusion of propofol combined with epidural anesthesia can be used for pelvic floor reconstruction in middle and old patients with pelvic floor dysfunction.
【作者单位】：重庆市妇幼保健院麻醉科;重庆医科大学附属第一医院麻醉科;
【基金】：重庆市卫生局面上项目(2011-2-006)
【分类号】：R614

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